System and method for monitoring nitric oxide levels using a non-invasive, multi-band biosensor

ABSTRACT

A biosensor includes a PPG circuit that emits light directed at living tissue at a plurality of wavelengths. A first and second spectral response of light reflected from the tissue is obtained around a first wavelength and a second wavelength. Using absorption coefficients for substances at the plurality of wavelengths, concentration levels of a plurality of substances such as Nitric Oxide may then be determined from the spectral responses.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims priority under 35 U.S.C. §119 to U.S.Provisional Application No. 62/463,104 entitled, “SYSTEM AND METHOD FORMONITORING NITRIC OXIDE LEVELS USING A NON-INVASIVE, MULTI-BANDBIOSENSOR,” filed Feb. 24, 2017, and hereby expressly incorporated byreference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part to U.S. patent application Ser. No. 14/866,500entitled, “SYSTEM AND METHOD FOR GLUCOSE MONITORING,” filed Sep. 25,2015, and hereby expressly incorporated by reference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/490813 entitled, “SYSTEM AND METHOD FOR HEALTH MONITORING USING ANON-INVASIVE, MULTI-BAND BIOSENSOR 500,” filed Apr. 18, 2017 and herebyexpressly incorporated by reference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/489391 entitled, “SYSTEM AND METHOD FOR A BIOSENSOR 500 MONITORINGAND TRACKING BAND,” filed Apr. 17, 2017 and hereby expresslyincorporated by reference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/485816 entitled, “SYSTEM AND METHOD FOR A DRUG DELIVERY AND BIOSENSOR500 PATCH,” filed Apr. 12, 2017 and hereby expressly incorporated byreference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/400,916 entitled, “SYSTEM AND METHOD FOR HEALTH MONITORING INCLUDINGA REMOTE DEVICE,” filed Jan. 6, 2017 and hereby expressly incorporatedby reference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/404,117 entitled, “SYSTEM AND METHOD FOR HEALTH MONITORING INCLUDINGA USER DEVICE AND BIOSENSOR,” filed Jan. 11, 2017 and hereby expresslyincorporated by reference herein.

The present application claims priority under 35 U.S.C. §120 as acontinuation in part application to U.S. patent application Ser. No.15/462700 entitled, “SYSTEM AND METHOD FOR ATOMIZING AND MONITORING ADRUG CARTRIDGE DURING INHALATION TREATMENTS,” filed Mar. 17, 2017 andhereby expressly incorporated by reference herein, which claims priorityunder 35 U.S.C. §119 to U.S. Provisional Application No. 62/457138entitled, “SYSTEM AND METHOD FOR ATOMIZING AND MONITORING A DRUGCARTRIDGE DURING INHALATION TREATMENTS,” filed Feb. 9, 2017, and herebyexpressly incorporated by reference herein.

FIELD

This application relates to a system and methods of non-invasive,autonomous health monitoring, and in particular a health monitoringsensor that non-invasively monitors Nitric Oxide (NO) levels in bloodvessels.

BACKGROUND

Various invasive methods have been developed for measurement of NitricOxide (NO) levels using one or more types of techniques to remove cellsfrom various types of bodily fluids. The methods usually require drawingblood from a blood vessel using a needle and syringe. The blood sampleis then transported to a lab for analysis to determine NO levels usingphysical or chemical measurements. For example, in one current method, ablood sample is inserted into a semi-permeable vessel including an NOreacting substance that traps NO diffusing thereinto. A simple physicalor chemical detection method is then used to measure the levels of theNO.

These known in vitro measurements of NO levels have disadvantages. Theprocess of obtaining blood samples is time consuming, inconvenient andpainful to a patient. It may also disrupt sleep of the patient. Themeasurements of the NO levels are not continuous and may only be updatedby taking another blood sample. The measurements must often then bemanually recorded into the patient's electronic medical record.

One current non-invasive method is known for measuring oxygen saturationin blood vessels using pulse oximeters. Pulse oximeters detect oxygensaturation of hemoglobin by using, e.g., spectrophotometry to determinespectral absorbencies and determining concentration levels of oxygenbased on Beer-Lambert law principles. In addition, pulse oximetry mayuse photoplethysmography (PPG) methods for the assessment of oxygensaturation in pulsatile arterial blood flow. The subject's skin at a‘measurement location’ is illuminated with two distinct wavelengths oflight and the relative absorbance at each of the wavelengths isdetermined. For example, a wavelength in the visible red spectrum (forexample, at 660 nm) has an extinction coefficient of hemoglobin thatexceeds the extinction coefficient of oxihemoglobin. At a wavelength inthe near infrared spectrum (for example, at 940 nm), the extinctioncoefficient of oxihemoglobin exceeds the extinction coefficient ofhemoglobin. The pulse oximeter filters the absorbance of the pulsatilefraction of the blood, i.e. that due to arterial blood (AC components),from the constant absorbance by nonpulsatile venous or capillary bloodand other tissue pigments (DC components), to eliminate the effect oftissue absorbance to measure the oxygen saturation of arterial blood.Such PPG techniques are heretofore been limited to determining oxygensaturation.

As such, there is a need for a patient monitoring system and method thatincludes a continuous and non-invasive biosensor configured to monitorconcentration levels of NO in blood flow in vivo.

SUMMARY

According to a first aspect, a biosensor for monitoring nitric oxide(NO) of a patient in vivo includes a PPG circuit and a processingcircuit. The PPG circuit is configured to generate at least a firstspectral response for light reflected around a first wavelength fromskin tissue of the patient and generate at least a second spectralresponse for light reflected around a second wavelength from the skintissue of the patient. The processing circuit is configured to obtain avalue L_(λ1) using the first spectral response, wherein the value L_(λ1)isolates the first spectral response due to pulsating arterial bloodflow; obtain a value L_(λ2) using the second spectral response, whereinthe value L_(λ2) isolates the second spectral response due to pulsatingarterial blood flow; obtain a value R_(λ1, λ2) from a ratio of the valueL_(λ1, λ2) and the value L_(λ2); and obtain a concentration level ofnitric oxide using the value R_(λ1, λ2) and a calibration database. Thecalibration database is used to correlate the value R_(λ1, λ2) and theconcentration level of nitric oxide (NO).

According to a second aspect, a biosensor for monitoring nitric oxide(NO) of a patient in vivo comprises a PPG circuit and a processingcircuit. The PPG circuit is configured to generate at least one spectralresponse from light reflected around a range of wavelengths from skintissue of the patient. The processing circuit is configured to determinean absorbance spectra curve for hemoglobin from the spectral response;determine a degree of shift of the absorbance spectra curve ofhemoglobin due at least to a presence of NO; access a calibrationdatabase that include correlations of degrees of shifts of theabsorbance spectra to concentration levels of nitric oxide (NO); andobtain a concentration level of nitric oxide using the calibrationdatabase.

In a third aspect, a method is described for monitoring nitric oxide(NO) of a patient in vivo that includes obtaining at least a firstspectral response for light reflected around a first wavelength fromskin tissue of the patient and obtaining at least a second spectralresponse for light reflected around a second wavelength from the skintissue of the patient. The method further includes obtaining a value Lλ1using the first spectral response, wherein the value Lλ1 isolates thefirst spectral response due to pulsating arterial blood flow; obtaininga value Lλ2 using the second spectral response, wherein the value Lλ2isolates the second spectral response due to pulsating arterial bloodflow; and obtaining a value Rλ1, λ2 from a ratio of the value Lλ1 andthe value Lλ2. The method further includes obtaining a concentrationlevel of nitric oxide using the value Rλ1, λ2 and a calibrationdatabase, wherein the calibration database correlates the value Rλ1, λ2and the concentration level of nitric oxide (NO).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A and FIG. 1B illustrate a perspective view of an embodiment of abiosensor.

FIG. 2A and FIG. 2B illustrate a perspective view of another embodimentof a biosensor.

FIG. 3 illustrates a perspective view of another embodiment of abiosensor for detecting NO levels.

FIG. 4 illustrates a schematic block diagram of an exemplary embodimentof components of the biosensor.

FIG. 5 illustrates a schematic block diagram illustrating an embodimentof the PPG circuit in more detail.

FIG. 6 illustrates a logical flow diagram of an exemplary embodiment ofa method for measuring nitric oxide (NO) in blood vessels.

FIG. 7 illustrates a logical flow diagram of an embodiment of a methodfor determining concentration of one or more additional substances usingBeer-Lambert principles.

FIG. 8A and FIG. 8B illustrate schematic block diagrams of an embodimentof a method for photoplethysmography (PPG) techniques in more detail.

FIG. 9 illustrates a schematic diagram of a graph of actual clinicaldata obtained using PPG techniques at a plurality of wavelengths.

FIG. 10 illustrates a logical flow diagram of an embodiment of a methodof the biosensor.

FIG. 11 illustrates a logical flow diagram of an exemplary method todetermine levels of NO using the spectral response at a plurality ofwavelengths.

FIG. 12 illustrates a logical flow diagram of an exemplary method todetermine levels of NO using the spectral response at a plurality ofwavelengths in more detail.

FIG. 13 illustrates a schematic block diagram of an exemplary embodimentof a graph illustrating the extinction coefficients over a range offrequencies for a plurality of hemoglobin species.

FIG. 14 illustrates a schematic block diagram of an exemplary embodimentof a graph illustrating a shift in absorbance peaks of hemoglobin in thepresence of NO.

FIG. 15 illustrates a schematic block diagram of an exemplary embodimentof a graph illustrating a shift in absorbance peaks of oxygenated anddeoxygenated hemoglobin (HB) in the presence of nitric oxide NO.

FIG. 16 illustrates a logical flow diagram of an exemplary embodiment ofa method for measuring NO concentration levels in vivo using shifts inabsorbance spectra.

FIG. 17 illustrates a logical flow diagram of an exemplary embodiment ofa method for measuring NO concentration levels using one or moremeasurement techniques.

FIG. 18 illustrates a logical flow diagram of an embodiment of a methodfor monitoring NO measurements in vivo.

FIG. 19 illustrates a logical flow diagram of an embodiment of a methodfor adjusting operation of the biosensor in response to a position ofthe biosensor.

FIG. 20 illustrates a schematic block diagram of an embodiment of anexemplary network in which the the biosensor described herein mayoperate.

FIG. 21 illustrates a schematic block diagram of an embodiment of anetwork illustrating interoperability of a plurality of biosensors.

FIG. 22A and FIG. 22B illustrate an embodiment of a typical waveform ofa PPG signal reflecting an arterial pressure waveform.

FIG. 23 illustrates a schematic drawing of an exemplary embodiment ofresults of a spectral response obtained using an embodiment of thebiosensor from a first patient.

FIG. 24 illustrates a schematic drawing of an exemplary embodiment ofresults of a filtered spectral response.

FIG. 25 illustrates a schematic drawing of an exemplary embodiment ofresults of an I_(DC) signal generated using the filtered spectralresponse.

FIG. 26 illustrates a schematic drawing of an exemplary embodiment ofresults of an I_(AC) signal.

FIG. 27 illustrates a schematic drawing of an exemplary embodiment ofresults of L values obtained over a time period.

FIG. 28 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged L values.

FIG. 29 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged R values.

FIG. 30 illustrates a schematic drawing of an exemplary embodiment ofresults of R values determined using a plurality of methods.

FIG. 31 illustrates a schematic drawing of an exemplary embodiment ofresults of R values for a plurality of wavelength ratios.

FIG. 32 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged R values for a plurality of wavelength ratios.

FIG. 33 illustrates a schematic drawing of an exemplary embodiment of acalibration curve for correlating oxygen saturation levels (SpO2) with Rvalues.

FIG. 34A illustrates a perspective view of an exemplary embodiment of abiosensor with a PPG circuit.

FIG. 34B illustrates a schematic block drawing of an exemplaryembodiment of the PPG circuit in more detail.

FIG. 35 illustrates a logical flow diagram of an exemplary embodiment ofa method for determining heart rate.

FIG. 36 illustrates a logical flow diagram of an exemplary embodiment ofa method for determining cardiac cycle.

FIG. 37 illustrates a logical flow diagram of an exemplary embodiment ofa method for determining an absorption rate of a substance

FIG. 38 illustrates a schematic block diagram of an embodiment of acalibration database.

DETAILED DESCRIPTION

The word “exemplary” or “embodiment” is used herein to mean “serving asan example, instance, or illustration.” Any implementation or aspectdescribed herein as “exemplary” or as an “embodiment” is not necessarilyto be construed as preferred or advantageous over other aspects of thedisclosure. Likewise, the term “aspects” does not require that allaspects of the disclosure include the discussed feature, advantage, ormode of operation.

Embodiments will now be described in detail with reference to theaccompanying drawings. In the following description, numerous specificdetails are set forth in order to provide a thorough understanding ofthe aspects described herein. It will be apparent, however, to oneskilled in the art, that these and other aspects may be practicedwithout some or all of these specific details. In addition, well knownsteps in a method of a process may be omitted from flow diagramspresented herein in order not to obscure the aspects of the disclosure.Similarly, well known components in a device may be omitted from figuresand descriptions thereof presented herein in order not to obscure theaspects of the disclosure.

Overview of Measurement of NO Levels

Embodiments described herein include a biosensor having an opticalmulti-band wavelength PPG sensor configured to determine NO levels invitro in arterial blood, arteries, vessels and/or surrounding tissue.The non-invasive methods of embodiments of the biosensor may have avariety of uses, e.g., for monitoring of NO levels and diagnosis ofvarious conditions related to NO levels. The biosensor may detectoverproduction or underproduction of NO levels that have been associatedwith many different conditions. For example, NO production is related toendothelium-derived relaxing factor (EDRF). In addition, NO is a highlypotent endogenous vasodilator. NO levels may also be used as indicatorof inflammation, blood clotting, diabetes, dementia, Alzheimer's,post-traumatic stress syndrome (PTSD), and infections like sepsis.

Nitric oxide (NO) is produced by a group of enzymes called nitric oxidesynthases. These enzymes convert arginine into citrulline, producing NOin the process. Oxygen and NADPH are necessary co-factors. There arethree isoforms of nitric oxide synthase (NOS) named according to theiractivity or the tissue type in which they were first described. Theisoforms of NOS are neural NOS (or nNOS, type 1), inducible NOS (oriNOS, type 2), and endothelial NOS (or eNOS, type 3). These enzymes arealso sometimes referred to by number, so that nNOS is known as NOS1,iNOS is known as NOS2, and eNOS is NOS3. Despite the names of theenzymes, all three isoforms can be found in variety of tissues and celltypes. Two of the enzymes (nNOS and eNOS) are constitutively expressedin mammalian cells and synthesize NO in response to increases inintracellular calcium levels. In some cases, however, they are able toincrease NO production independently of calcium levels in response tostimuli such as shear stress.

In most cases NO production increases in proportion to the amount ofcalories or food consumed. Normally this is derived from the eNOS typeNO production, and the body uses the NO first as a vasodilator and alsoas a protective oxidation layer to prevent undesired oxides from passingthru the cells in the blood vessels walls. The amount of NO released inthis case is measured in small pulses and builds up as part of thenormal digestion process. In the case of type 1 or type 2 diabetics, thenormal levels of eNOS are abnormally low as found in recent clinicalstudies.

However iNOS activity is independent of the level of calcium in thecell, and all forms of the NOS isoforms are dependent on the binding ofcalmodulin. Increases in cellular calcium lead to increase in levels ofcalmodulin and the increased binding of calmodulin to eNOS and nNOSleads to a transient increase in NO production by these enzymes. Bycontrast iNOS is able to bind tightly to calmodulin even at extremelylow concentrations of calcium. Therefore iNOS activity does not respondto changes in calcium levels in the cell. As a result of the productionof NO by iNOS, it lasts much longer than other forms of isoforms of NOSand tends to produce much higher concentrations of NO in the body. Thisis likely the reason that iNOS levels are known to be elevated indementia & Alzheimer's patents and have increased calcium deposits intheir brain tissue.

Inducible iNOS levels are highly connected with sepsis infections whichtypically lead to large levels of NO in the blood stream, which in turnsleads to organ failure. Lastly abnormal amounts of nNOS levels aretypically associated with issues with blood pressure regulation,neurotransmission issues, and penal erection. Table 1 below summarizesthe NOS isoforms.

TABLE 1 Nitric Oxide Synthesis (NOS isoforms) Oosthuizen et al Table 2NOS isoforms Neural Inducible Endothelial (nNOS, type 1) (iNOS, type 2)(eNOS, type 3) Cells first identified in Neurons Macrophages EndotheliumOther cells expressing Myocytes Astrocytes Neurons Astrocytes MicrogliaIntracellular localization Soluble or membrane bound Soluble or membranebound Largely membrane bound Ca²⁺ dependency Activity depends onActivity is independent of Activity depends on elevated Ca²⁺ elevatedCa²⁺ elevated Ca²⁺ Expression Constitutive inducible under InducibleConstitutive certain circumstances, eg, trauma Amounts of NO releasedSmall, pulses Large, continuous Small, pulses Proposed functionRegulation Host defense Regulation Activators GlutamateLipopolysaccharide Acetylcholine Noradrenaline Data adapted from Yun etal (1997) and Moncada et al (1997).

Thus, the overproduction or underproduction of NO levels may beassociated with many different health conditions. Embodiments of thebiosensor described herein may continuously monitor NO levelsnon-invasively in vivo without need for blood samples. The NO levels ofa patient may be continuously displayed and monitored. The NO levels maybe used for diagnosis of one or more of these or other healthconditions. Measuring NO or related compounds may provide early warninginformation about a patient's condition and allow for more immediatemedical intervention. Since current measurement methods of NO do notallow health care professionals or even home care patients to measure NOcontinuously in blood vessels, the biosensor described herein may bepotentially lifesaving for critical conditions. Very often traumapatients require frequent monitoring and invasive blood tests are theonly method to sense worsening conditions prior to emergency conditions.The described non-invasive biosensor measures NO levels in blood vesselsand provides efficiency to a host of current methods and treatmentprocedures in medical facilities around the globe. For example, themeasurement of nitric oxide (NO) levels in blood vessels describedherein provides a much earlier warning to care providers thatintervention is needed for patient care.

Overview of Biosensor

In an embodiment, a biosensor includes a PPG circuit, a processingcircuit, optional on-board display and a wireless or wired transceiver.The PPG circuit is configured to transmit light at a plurality ofwavelengths directed at skin tissue of a patient. The PPG circuit isconfigured to detect light reflected from the skin tissue of the patientand generate spectral responses at a plurality of wavelengths. Theprocessing circuit is configured to obtain a measurement of NO levelsusing the spectral responses at the plurality of wavelengths using oneor more measurement techniques described herein. An indication of the NOlevel may then be displayed on a display of the biosensor. The biosensormay transmit the measurements of NO levels via a wireless or wiredtransceiver to a remote display.

Embodiments—Biosensor Form Factors

FIG. 1A and FIG. 1B illustrate a perspective view of an embodiment of abiosensor 100. In this embodiment, the biosensor 100 includes a fingerattachment 102. The finger attachment 102 includes the PPG circuit 110and is configured to securely hold a finger that is inserted into thefinger attachment 102.

In use, a patient places a finger inside the finger attachment 102. Thebiosensor 100 is configured to monitor nitric oxide (NO) levels in theblood vessels of the patient. A PPG circuit 110 in the biosensor 100 isconfigured to transmit light at a plurality of wavelengths directed atskin tissue of the finger of the patient. The PPG circuit 110 isconfigured to detect light reflected from the skin tissue of the fingerand generate spectral responses at a plurality of wavelengths. Aprocessing circuit in the biosensor 100 is configured to obtain ameasurement of NO levels from the spectral responses at the plurality ofwavelengths using one or more measurement techniques described herein.The NO levels may be continuously monitored, e.g. the NO measurementsmay be obtained a plurality of times per minute and averaged over apredetermined time period. An indication of the NO levels may then bedisplayed on a display of the biosensor 100.

The biosensor 100 includes one or more types of displays of the measurednitric oxide (NO) levels. The displays may include, e.g., arterialnitric oxide saturation level 104 (such as SpNO). The display mayinclude a bar meter 106 illustrating a relative measured nitric oxidelevel. The display may include a dial type display 108 that indicates arelative measured nitric oxide level. The biosensor 100 may display themeasured nitric oxide level in mmol/liter units 112. These types ofdisplays are examples only and other types of display may be employed toindicate the level of NO measured in a patient.

The biosensor 100 may also display other patient vitals such as heartrate, e.g. beats per minute (bpm) 114. The biosensor 100 may alsoinclude a power control.

The biosensor 100 may be implemented in other compact form factors, suchas on a patch, wrist band or ear piece. Due to its compact form factor,the biosensor 100 may be configured for measurements on various skinsurfaces of a patient, including on a forehead, arm, wrist, abdominalarea, chest, leg, ear, ear lobe, finger, toe, ear canal, etc.

FIG. 2A and FIG. 2B illustrate a perspective view of another embodimentof a biosensor 100 for detecting NO levels. In this embodiment, thebiosensor 100 is implemented with an adjustable band 200. The adjustableband 200 may be configured to fit around a wrist, arm, leg, ankle, etc.FIG. 2A illustrates a first side 202 of the biosensor 100 that includesat least one opening for the PPG circuit 110 to emit light directed toand detect light reflected from skin tissue of a user. FIG. 2Billustrates a second side 204 of the biosensor 100 that may include adisplay (not shown). A USB or other port 206 may be implemented totransmit data to and from the biosensor 100. The biosensor 100 may alsoinclude a wireless transceiver.

FIG. 3 illustrates a perspective view of another embodiment of abiosensor 100 for detecting NO levels. In this embodiment, the biosensor100 includes a PPG circuit 110 and a wired connection 300 forcommunicating data with a remote device, such as a patient display ormonitoring device. The biosensor 100 may be attached to different areasof tissue via an adhesive tape, adhesive backing or other means. Forexample, the biosensor 100 may be attached to a hand, arm, wrist,forehead, chest, abdominal area, ear, ear lobe, or other area of theskin or body or living tissue.

In another embodiment, the biosensor 100 is may be configured in anearpiece (not shown). The biosensor 100 is configured to transmit lightinto the ear canal from one or more optical fibers in an ear bud anddetect light from the ear canal using one or more optical fibers.

In one study, a mechanical contact of glass with the subject's skinsubstantially increased the amplitude of the observed PPG signal.Moreover, by increasing the force of the contact, the amplitude of thePPG signal in the area is increased. As such, increased compression ofthe biosensor 100 against skin tissue may enhance intensity of the PPGsignal. So compression of the biosensor 100 against the skin of apatient may be considered during use of biosensor 100 in its one or moreform factors. The article by Kamshilin A A, Nippolainen E, Sidorov I S,et al. entitled “A new look at the essence of the imagingphotoplethysmography” in Scientific Reports, May 21, 2015, 5:10494 anddoi:10.1038/srep10494 includes further details on spatial distributionof PPG intensity amplitude for different forces of contact, and ishereby incorporated by reference herein.

Embodiment-Biosensor Components

FIG. 4 illustrates a schematic block diagram of an exemplary embodimentof components of the biosensor 100. The biosensor 100 includes the PPGcircuit 110 as described in more detail herein. The PPG circuit 110 maybe configured to detect oxygen saturation (SaO2 or SpO2) levels in bloodflow, as well as heart rate and blood pressure. In addition, the PPGcircuit 110 is configured to detect concentration levels or indicatorsof NO levels in the blood.

The biosensor 100 also includes one or more processing circuits 402communicatively coupled to a memory device 404. In one aspect, thememory device 404 may include one or more non-transitory processorreadable memories that store instructions which when executed by the oneor more processing circuits 402, causes the one or more processingcircuits 402 to perform one or more functions described herein. Thememory device 404 may also include an EEPROM or other type of memory tostore a patient identification (ID) 408 that is associated with apatient being monitored by the biosensor 100. The patient identification408 may include a number, name, date of birth, password, etc. The memorydevice 404 may also store an electronic medical record (EMR) 408 orportion of the EMR 408 associated with the patient being monitored bythe biosensor 100. The biosensor data obtained by the biosensor 100 maybe stored in the EMR 408. The processing circuit 42 may be co-locatedwith one or more of the other circuits in the biosensor 100 in a samephysical encasement or located separately in a different physicalencasement or located remotely. In an embodiment, the biosensor 100 isbattery operated and includes a battery 420, such as a lithium ionbattery.

The biosensor 100 further includes a transceiver 412. The transceiver412 may include a wireless or wired transceiver configured tocommunicate with one or more devices over a LAN, MAN and/or WAN. In oneaspect, the transceiver 412 may include a Bluetooth enabled (BLE)transceiver or IEEE 802.11ah, Zigbee, IEEE 802.15-11 or WLAN (such as anIEEE 802.11 standard protocol) compliant wireless transceiver. Inanother aspect, the transceiver 412 may operate using RFID, short rangeradio frequency, infrared link, or other short range wirelesscommunication protocol. In another aspect, the transceiver 412 may alsoinclude or alternatively include an interface for communicating over acellular radio access network, such as an Universal MobileTelecommunications System (UMTS) Terrestrial Radio Access Network(UTRAN), Long Term Evolution (LTE) Evolved UTRAN (E-UTRAN), and/orLTE-Advanced (LTE-A) or other types of cellular networks. In anembodiment, the transceiver 412 may include a thin foil for an antennathat is specially cut and includes a carbon pad contact to a mainprinted circuit board (PCB) of the biosensor 100. This type of antennais inexpensive to manufacture and may be printed on the inside of anenclosure for the biosensor 100 situated away from the skin of thepatient to minimize absorption. The transceiver 412 may also include awired transceiver including a port or interface, e.g., a USB port orother type of wired connection port, for communication with one or moreother devices using Ethernet, IP, or other protocols over a LAN, MANand/or WAN.

The biosensor 100 may also include a temperature sensor 414 configuredto detect a temperature of a patient. For example, the temperaturesensor 414 may include an array of sensors (e.g., 16×16 pixels)positioned on a side of the biosensor 100 with the PPG circuit 110 suchthat the array of sensors are adjacent to the skin of the patient. Thearray of sensors is configured to detect a temperature of the patientfrom the skin. The temperature sensor 414 may also be used to calibratethe PPG circuit 110.

The biosensor 100 may also include a display 416 for displayingbiosensor data. Alternatively or in addition thereto, the transceiver412 may communicate biosensor data, such as NO levels, to a remotedevice for display.

Embodiment-PPG Circuit

FIG. 5 illustrates a schematic block diagram illustrating an embodimentof the PPG circuit 110 in more detail. The PPG circuit 110 includes alight source 120 configured to emit a plurality of wavelengths of lightacross various spectrums. For example, the light source 120 mat includea plurality of LEDs 122 a-n. The PPG circuit 110 is configured to directthe emitted light at an outer or epidermal layer of skin tissue of apatient through at least one aperture 128 a. The plurality of LEDs 122are configured to emit light in one or more spectrums, includinginfrared (IR) light, ultraviolet (UV) light, near IR light or visiblelight, in response to driver circuit 118. For example, the biosensor 100may include a first LED 122 a that emits visible light and a second LED122 b that emits infrared light and a third LED 122 c that emits UVlight, etc. In another embodiment, one or more of the light sources 122a-n may include tunable LEDs or lasers operable to emit light over oneor more frequencies or ranges of frequencies or spectrums in response todriver circuit 118.

In an embodiment, the driver circuit 118 is configured to control theone or more LEDs 122 a-n to generate light at one or more frequenciesfor predetermined periods of time. The driver circuit 118 may controlthe LEDs 122 a-n to operate concurrently or consecutively. The drivercircuit 118 is configured to control a power level, emission period andfrequency of emission of the LEDs 122 a-n. The biosensor 100 is thusconfigured to emit one or more wavelengths of light in one or morespectrums that is directed at the surface or epidermal layer of the skintissue of a patient.

The PPG circuit 110 further includes one or more photodetector circuits130 a-n. For example, a first photodetector circuit 130 may beconfigured to detect visible light and the second photodetector circuit130 may be configured to detect IR light. The first photodetectorcircuit 130 and the second photodetector circuit 130 may also include afirst filter 160 and a second filter 162 configured to filter ambientlight and/or scattered light. For example, in some embodiments, onlylight reflected at an approximately perpendicular angle to the skinsurface of the patient is desired to pass through the filters. The firstphotodetector circuit 130 and the second photodetector circuit 132 arecoupled to a first A/D circuit 138 and a second A/D circuit 140.Alternatively, a single A/D circuit may be coupled to each of thephotodetector circuits 130 a-n.

In another embodiment, a single photodetector circuit 130 may beimplemented operable to detect light over multiple spectrums orfrequency ranges. For example, the photodetector circuit 130 may includea Digital UV Index/IR/Visible Light Sensor such as Part No. Si1145 fromSilicon Labs™.

The one or more photodetector circuits 130 include a spectrometer orother type of circuit configured to detect an intensity of light as afunction of wavelength or frequency to obtain a spectral response. Theone or more photodetector circuits 130 detect the intensity of lighteither transmitted through or reflected from tissue of a patient thatenters one or more apertures 128 b-n of the biosensor 100. For example,the light may be detected from transmissive absorption (e.g., through afingertip or ear lobe) or from reflection (e.g., reflected from aforehead or stomach tissue). The one or more photodetector circuits 130a-n then obtain a spectral response of the reflected light by measuringthe intensity of light at one or more wavelengths.

In another embodiment, the light source 120 may include a broad spectrumlight source, such as a white light to infrared (IR) or near IR LED 122,that emits light with wavelengths from e.g. 350 nm to 2500 nm. Broadspectrum light sources with different ranges may be implemented. In anaspect, a broad spectrum light source is implemented with a range across100 nm wavelengths to 2000 nm range of wavelengths in the visible, IRand/or UV frequencies. For example, a broadband tungsten light sourcefor spectroscopy may be used. The spectral response of the reflectedlight is then measured across the wavelengths in the broad spectrum,e.g. from 350 nm to 2500 nm, concurrently. In an aspect, a chargecoupled device (CCD) spectrometer may be configured in the photodetectorcircuit 130 to measure the spectral response of the detected light overthe broad spectrum.

FIG. 6 illustrates a logical flow diagram of an exemplary embodiment ofa method 600 for measuring NO in blood vessels. The biosensor 100non-invasively obtains an NO measurement related to the concentration ofNO in blood vessels at 602. The NO measurement is then displayed at 604.

A care provider may then determine health conditions or risks using theNO measurement and determine to perform additional tests or providemedical care. For example, the biosensor 100 non-invasively monitors anNO measurement, such as the NO concentration level or indicator ofamount of nitric oxide, in blood vessels. The NO measurement may berepresented by a saturation of nitric oxide SpNO in the blood or othervalues representing NO levels in the blood vessels, such as mmol/liter.

The NO measurement of a patient may be compared to predetermined levelsat 606. For example, the predetermined thresholds may be a range ofaverage or mean NO measurements of a sample healthy population. The NOmeasurement of an individual patient may then be compared to the normalrange derived from the sample population. Depending on the comparison,the NO measurement may be determined within normal ranges.Alternatively, the NO measurement may be determined to be lower orhigher than predetermined normal ranges indicating one or more healthrisks. For example, diabetic conditions may result in lower than normalNO levels while carbon monoxide poisoning or septic risk may result inhigher than normal NO levels. Other compounds may also cause unsafelevels of NO in blood vessels, such as lidocaine and nitrates such asnitroglycerine, nitric oxide, or water sources contaminated by runoffcontaining nitrogen based fertilizers, anti-malaria drug dapsone,benzocaine, cyanide, anesthesia, nitroglycerin, nitrate drugs, watercontaminated with nitro based fertilizers, landocaine, etc. Anindication may be displayed that the NO measurement is within thepredetermined normal range. In addition, a warning may be displayed whenthe NO measurement of the patient is not within a predetermined normalrange at 608.

Embodiment-PPG Measurement of NO Levels

One or more of the embodiments of the biosensor 100 described herein isconfigured to detect a concentration level or indicator of one or moresubstances within arterial blood flow using photoplethysmography (PPG)techniques. The biosensor 100 may detect NO concentration level, insulinresponse, vascular health, cardiovascular sensor, cytochrome P450proteins (e.g. one or more liver enzymes or reactions), digestion phase1 and 2 or caloric intake. The biosensor 100 may even be configured todetect proteins or other elements or compounds associated with cancer.The biosensor 100 may also detect various electrolytes and many commonblood analytic levels, such as bilirubin amount and sodium andpotassium. For example, the biosensor 100 may detect sodium NACLconcentration levels in the arterial blood flow to determinedehydration. The biosensor 100 may also detect blood alcohol levels invivo in the arterial blood flow. The biosensor 100 may also detect bloodpressure, peripheral oxygen (SpO₂ or SaO₂) saturation, heart rate,respiration rate or other patient vitals. Because blood flow to the skincan be modulated by multiple other physiological systems, the PPG sensor110 may also be used to monitor breathing, hypovolemia, and othercirculatory conditions.

In use, the biosensor 100 performs PPG techniques using the PPG circuit110 to detect the concentration levels of one or more substances inblood flow. In one aspect, the biosensor 100 receives reflected lightfrom skin tissue to obtain a spectral response. The spectral responseincludes a spectral curve that illustrates an intensity or power orenergy at a frequency or wavelength in a spectral region of the detectedlight.

The ratio of the resonance absorption peaks from two differentfrequencies can be calculated and based on the Beer-Lambert law used toobtain various levels of substances in the blood flow. First, thespectral response of a substance or substances in the arterial bloodflow is determined in a controlled environment, so that an absorptioncoefficient α_(g1) can be obtained at a first light wavelength λ1 and ata second wavelength λ2. According to the Beer-Lambert law, lightintensity will decrease logarithmically with path length l (such asthrough an artery of length l). Assuming then an initial intensityI_(in) of light is passed through a path length l, a concentration C_(g)of a substance may be determined using the following equations:

At the first wavelength λ₁, I₁=I_(in1)*10^(−(α) ^(g1) ^(C) ^(gw) ^(+α)^(w1) ^(C) ^(W) ⁾*^(l)

At the second wavelength λ₂, I₂=I_(in2)*10^(−(α) ^(g2) ^(C) ^(gw) ^(+α)^(w2) ^(C) ^(W) ⁾*^(l)

wherein:

I_(in1) is the intensity of the initial light at λ₁

I_(in2) is the intensity of the initial light at λ₂

α_(g1) is the absorption coefficient of the substance in arterial bloodat λ₁

α_(g2) is the absorption coefficient of the substance in arterial bloodat λ₂

α_(w1) is the absorption coefficient of arterial blood at λ₁

α_(w2) is the absorption coefficient of arterial blood at λ₂

C_(gw) is the concentration of the substance and arterial blood

C_(w) is the concentration of arterial blood

Then letting R equal:

$R = \frac{{log10}\left( \frac{I\; 1}{I\mspace{11mu} {in}\mspace{11mu} 1} \right)}{{l{og10}}\left( \frac{I\; 2}{I\mspace{11mu} {in}{\; \;}2} \right)}$

The concentration of the substance Cg may then be equal to:

${Cg} = {\frac{Cgw}{{Cgw} + {Cw}} = \frac{{\alpha_{w2}R} - \alpha_{w\; 1}}{{\left( {\alpha_{w2} - \alpha_{gw2}} \right)*R} - \left( {\alpha_{w\; 1} - \alpha_{{gw}\; 1}} \right)}}$

The biosensor 100 may thus determine the concentration of varioussubstances in arterial blood using spectroscopy of at least twodifferent wavelengths from the Beer-Lambert principles. For example, thebiosensor 100 may function as a pulse oximeter using similar principlesunder Beer-lambert law to determine pulse and oxygen saturation levelsin pulsating arterial blood flow. For example, a first wavelength atapproximately 940 nm and a second wavelength at approximately 660 nm maybe used to determine oxygen saturation levels (SpO₂). In addition, thebiosensor 100 may determine concentration levels of one or moreadditional substances in blood vessels.

FIG. 7 illustrates a logical flow diagram of an embodiment of a method700 for determining concentration level of NO using Beer-Lambertprinciples. The biosensor 100 transmits light at least at a firstpredetermined wavelength and at a second predetermined wavelength. Thebiosensor 100 detects the light (reflected from the skin or transmittedthrough the skin) and determines the spectral response at the firstwavelength at 702 and at the second wavelength at 704. The biosensor 100then determines an indicator or concentration level of NO using thespectral responses of the first and second wavelength at 706. Ingeneral, the first predetermined wavelength is selected that has a highabsorption coefficient for No while the second predetermined wavelengthis selected that has a lower absorption coefficient for NO. Thus, it isgenerally desired that the spectral response for the first predeterminedwavelength have a higher intensity level in response to NO than thespectral response for the second predetermined wavelength.

In another aspect, the biosensor 100 may transmit light at the firstpredetermined wavelength in a range of approximately 1 nm to 50 nmaround the first predetermined wavelength. Similarly, the biosensor 100may transmit light at the second predetermined wavelength in a range ofapproximately 1 nm to 50 nm around the second predetermined wavelength.The range of wavelengths is determined based on the spectral responsesince a spectral response may extend over a range of frequencies, not asingle frequency (i.e., it has a nonzero linewidth). The light that isreflected or transmitted by NO may spread over a range of wavelengthsrather than just the single predetermined wavelength. In addition, thecenter of the spectral response may be shifted from its nominal centralwavelength or the predetermined wavelength. The range of 1 nm to 50 nmis based on the bandwidth of the spectral response line and shouldinclude wavelengths with increased light intensity detected for thetargeted substance around the predetermined wavelength.

The first spectral response of the light over the first range ofwavelengths including the first predetermined wavelength and the secondspectral response of the light over the second range of wavelengthsincluding the second predetermined wavelengths is then generated at 702and 704. The biosensor 100 analyzes the first and second spectralresponses to detect an indicator or concentration level of NO in thearterial blood flow at 706.

FIG. 8A and FIG. 8B illustrate schematic block diagrams of an embodimentof a method for photoplethysmography (PPG) techniques in more detail.Photoplethysmography (PPG) is used to measure time-dependent volumetricproperties of blood in blood vessels due to the cardiac cycle. Forexample, the heartbeat affects volume of arterial blood flow and theconcentration of absorption levels being measured in the arterial bloodflow. As shown in FIG. 8A, over a cardiac cycle 802, pulsating arterialblood 804 changes the volume of blood flow in an artery.

Incident light I_(O) 812 is directed at a tissue site and a certainamount of light is reflected or transmitted 818 and a certain amount oflight is absorbed 820. At a peak of arterial blood flow or arterialvolume, the reflected/transmitted light I_(L) 814 is at a minimum due toabsorption by the venous blood 808, nonpulsating arterial blood 806,pulsating arterial blood 804, other tissue 810, etc. At a minimum ofarterial blood flow or arterial volume during the cardiac cycle, thetransmitted/reflected light I_(H) 816 is at a maximum due to lack ofabsorption from the pulsating arterial blood 804.

The biosensor 100 is configured to filter the reflected/transmittedlight I_(L) 814 of the pulsating arterial blood 804 from thetransmitted/reflected light I_(H) 816. This filtering isolates the lightdue to reflection/transmission of substances in the pulsating arterialblood 804 from the light due to reflection/transmission from venous (orcapillary) blood 808, other tissues 810, etc. The biosensor 100 may thenmeasure the concentration levels of one or more substances from thereflected/transmitted light I_(L) 814 in the pulsating arterial blood804.

For example, as shown in FIG. 8B, incident light I_(O) 812 is directedat a tissue site by an LED 122 at one or more wavelengths. Thereflected/transmitted light I 818 is detected by photodetector 130. At apeak of arterial blood flow or arterial volume, the reflected lightI_(L) 814 is at a minimum due to absorption by venous blood 808,non-pulsating arterial blood 806, pulsating arterial blood 804, othertissue 810, etc. At a minimum of arterial blood flow or arterial volumeduring the cardiac cycle, the Incident or reflected light I_(H) 816 isat a maximum due to lack of absorption from the pulsating arterial blood804. Since the light I 818 is reflected or traverses through a differentvolume of blood at the two measurement times, the measurement providedby a PPG sensor is said to be a ‘volumetric measurement’ descriptive ofthe differential volumes of blood present at a certain location withinthe patient's arteriolar bed at different times. Though the above hasbeen described with respect to arterial blood flow, the same principlesdescribed herein may be applied to venous blood flow.

In general, the relative magnitudes of the AC and DC contributions tothe reflected/transmitted light signal I 818 may be used tosubstantially determine the differences between the diastolic time andthe systolic points. In this case, the difference between the reflectedlight I_(L) 814 and reflected light I_(H) 816 corresponds to the ACcontribution of the reflected light 818(e.g. due to the pulsatingarterial blood flow). A difference function may thus be computed todetermine the relative magnitudes of the AC and DC components of thereflected light I 818 to determine the magnitude of the reflected lightI_(L) 814 due to the pulsating arterial blood 804. The describedtechniques herein for determining the relative magnitudes of the AC andDC contributions is not intended as limiting. It will be appreciatedthat other methods may be employed to isolate or otherwise determine therelative magnitude of the light I_(L) 814 due to pulsating arterialblood flow.

FIG. 9 illustrates a schematic diagram of a graph of actual clinicaldata obtained using an embodiment of the biosensor 100 and PPGtechniques at a plurality of wavelengths. In one aspect, the biosensor100 is configured to emit light having a plurality of wavelengths duringa measurement period. The light at each wavelength (or range ofwavelengths) may be transmitted concurrently or sequentially. Theintensity of the reflected light at each of the wavelengths (or range ofwavelengths) is detected and the spectral response is measured over themeasurement period. The spectral response 908 for the plurality ofwavelengths obtained using an embodiment of the biosensor in clinicaltrials is shown in FIG. 9. In this clinical trial, two biosensors 100attached to two separate fingertips of a patient were used to obtain thespectral responses 908. The first biosensor 100 obtained the spectralresponse for a wavelength at 940 nm 610, a wavelength at 660 nm 612 anda wavelength at 390 nm 614. The second biosensor 100 obtained thespectral response for a wavelength at 940 nm 616, a wavelength at 592 nm618 and a wavelength at 468 nm 620.

In one aspect, the spectral response of each wavelength may be alignedbased on the systolic 602 and diastolic 604 points in their spectralresponses. This alignment is useful to associate each spectral responsewith a particular stage or phase of the pulse-induced local pressurewave within the blood vessel (which may mimic the cardiac cycle 906 andthus include systolic and diastolic stages and sub-stages thereof). Thistemporal alignment helps to determine the absorption measurementsacquired near a systolic point in time of the cardiac cycle and near thediastolic point in time of the cardiac cycle 906 associated with thelocal pressure wave within the patient's blood vessels. This measuredlocal pulse timing information may be useful for properly interpretingthe absorption measurements in order to determine the relativecontributions of the AC and DC components measured by the biosensor 110.So for one or more wavelengths, the systolic points 902 and diastolicpoints 904 in the spectral response are determined. These systolicpoints 902 and diastolic points 904 for the one or more wavelengths maythen be aligned as a method to discern concurrent responses across theone or more wavelengths.

In another embodiment, the the systolic points 902 and diastolic points904 in the absorbance measurements are temporally correlated to thepulse-driven pressure wave within the arterial blood vessels—which maydiffer from the cardiac cycle. In another embodiment, the biosensor 100may concurrently measure the intensity reflected at each the pluralityof wavelengths. Since the measurements are concurrent, no alignment ofthe spectral responses of the plurality of wavelengths may be necessary.FIG. 9 illustrates the spectral response of the plurality of wavelengthswith the systolic points 902 and diastolic points 904 aligned.

FIG. 10 illustrates a logical flow diagram of an embodiment of a method1000 of the biosensor 100. In one aspect, the biosensor 100 emits anddetects light at a plurality of predetermined frequencies orwavelengths, such as approximately 940 nm, 660 nm, 390 nm, 592 nm, and468 nm. The light is pulsed for a predetermined period of time (such as100 usec or 200 Hz) sequentially or simultaneously at each predeterminedwavelength. In another aspect, light may be pulsed in a wavelength rangeof 1 nm to 50 nm around each of the predetermined wavelengths. Forexample, for the predetermined wavelength 390 nm, the biosensor 100 maytransmit light directed at skin tissue of the patient in a range of 360nm to 410 nm including the predetermined wavelength 390 nm. For thepredetermined wavelength of 940 nm, the biosensor 100 may transmit lightdirected at the skin tissue of the patient in a range of 920 nm to 975nm. In another embodiment, the light is pulsed simultaneously at leastat each of the predetermined wavelengths (and in a range around thewavelengths).

The spectral responses are obtained around the plurality of wavelengths,including at least a first wavelength and a second wavelength at 1002.The spectral responses may be measured over a predetermined period (suchas 300 usec.). This measurement process is repeated continuously, e.g.,pulsing the light at 10-100 Hz and obtaining spectral responses over adesired measurement period, e.g. from 1-2 seconds to 1-2 minutes or from2-3 hours to continuously over days or weeks. The absorption levels aremeasured over one or more cardiac cycles and systolic and diastolicpoints of the spectral response are determined. Because the human pulseis typically on the order of magnitude of one 1 Hz, typically the timedifferences between the systolic and diastolic points are on the orderof magnitude of milliseconds or tens of milliseconds or hundreds ofmilliseconds. Thus, spectral response measurements may be obtained at afrequency of around 10-100 Hz over the desired measurement period. Thespectral responses are obtained over one or more cardiac cycles andsystolic and diastolic points of the spectral responses are determined.

A low pass filter (such as a 5 Hz low pass filter) is applied to thespectral response signal at 1004. The relative contributions of the ACand DC components are obtained I_(AC+DC) and I_(AC). A peak detectionalgorithm is applied to determine the systolic and diastolic points at1006. The systolic and diastolic points of the spectral response foreach of the wavelengths may be aligned and may also be aligned withsystolic and diastolic points of an arterial pulse waveform or cardiaccycle.

Beer Lambert equations are then applied as described herein at 1008. Forexample, the L_(λ) values are then calculated for the wavelengths λ,wherein the L_(λ) values for a wavelength equals:

$L_{\lambda} = {{Log}\mspace{11mu} 10\left( \frac{{IAC} + {DC}}{IDC} \right)}$

wherein I_(AC+DC) is the intensity of the detected light with AC and DCcomponents and I_(DC) is the intensity of the detected light with the ACfiltered by the low pass filter. The value L_(λ) isolates the spectralresponse due to pulsating arterial blood flow, e.g. the AC component ofthe spectral response.

A ratio R of the L_(λ) values at two wavelengths may then be determined.For example,

${{Ratio}\mspace{14mu} R} = \frac{L\; {\lambda 1}}{L\; {\lambda 2}}$

The spectral responses may be measured and the L_(k) values and Ratio Rdetermined continuously, e.g. every 1-2 seconds, and the obtained L_(k)values and/or Ratio R averaged over a predetermined time period, such asover 1-2 minutes. The NO concentration levels may then be obtained fromthe averaged R values and a calibration database. The NO levelmeasurements are then displayed. The biosensor 100 may continuouslymonitor a patient over 2-3 hours or continuously over days or weeks.

The R_(390,940) value with L_(λ1=390 nm) and L_(λ2=940) may benon-invasively and quickly and easily obtained using the biosensor 100in a physician's office or other clinical setting or at home. Inparticular, in unexpected results, it is believed that nitric oxide NOlevels in the arterial blood flow is being measured at least in part bythe biosensor 100 at λ₁=390 nm. The wavelengths around 390 nm may alsobe used, e.g. 395 nm or a range from 370 nm to 410 nm. Since NO ispartly in a gaseous form in blood vessels (prior to adhesion tohemoglobin), the total NO concentration levels of in vitro bloodsamples, e.g. from a finger prick, are not detected as the NO gasdissipates. Thus, the biosensor 100 measurements to determine theL_(390 nm) values are the first time NO concentration levels in arterialblood flow have been measured directly in vivo. These and other aspectsof the biosensor 100 are described in more detail herein with clinicaltrial results.

Embodiment—Determination of NO Concentration Levels at a Plurality ofWavelengths

FIG. 11 illustrates a logical flow diagram of an exemplary method 1100to determine levels of NO using the spectral response at a plurality ofwavelengths. The absorption coefficient may be higher at otherwavelengths due to NO or NO isoforms or NO compounds. For example, theincreased intensity of light at a plurality of wavelengths may be due toreflectance by NO or NO isoforms or other NO compounds in the arterialblood flow. Another method for determining NO levels may then be used bymeasuring the spectral response and determining L and R values at aplurality of different wavelengths of light. In this example then, NOconcentration level is determined over multiple wavelengths. An examplefor calculating the concentration of one or more substances overmultiple wavelengths may be performed using a linear function, such asis illustrated herein below.

LN(I _(1−n))=Σ_(i=0) ^(n) μi*Ci

wherein,

I_(1−n)=intensity of light at wavelengths λ_(1−n)

μ_(n)=absorption coefficient of substance 1, 2, . . . n at wavelengthsλ_(1−n)

C_(n)=Concentration level of substance 1, 2, . . . n

When the absorption coefficients μ_(1−n) of NO or NOS isoforms or otherNO compounds are known at the wavelengths λ_(1−n), then theconcentration level C of the substances may be determined from thespectral responses at the wavelengths λ_(1−n) (and e.g., including arange of 1 nm to 50 nm around each of the wavelengths). Theconcentration level of NO may be isolated from the NOS isoforms or otherNO compounds by compensating for the concentration of the hemoglobincompounds. Thus, using the spectral responses at multiple frequenciesprovides a more robust determination of the concentration level of NO.

In use, the biosensor 100 transmits light directed at skin tissue at aplurality of wavelengths or over a broad spectrum at 1102. The spectralresponse of light from the skin tissue is detected at 1104, and thespectral response is analyzed for a plurality of wavelengths (and in oneaspect including a range of +/−10 to 50 nm around each of thewavelengths) at 1106. Then, the concentration level C of the substancemay be determined using the spectral response at the plurality ofwavelengths at 1108.

FIG. 12 illustrates a logical flow diagram of an exemplary method 1200to determine levels of NO using the spectral response at a plurality ofwavelengths in more detail. The spectral responses are obtained at 1202.The spectral response signals include AC and DC components I_(AC+DC). Alow pass filter (such as a 5 Hz low pass filter) is applied to each ofthe spectral response signals I_(AC+DC) to isolate the DC component ofeach of the spectral response signals I_(DC) at 1204. The AC fluctuationis due to the pulsatile expansion of the arteriolar bed due to thevolume increase in arterial blood. In order to measure the ACfluctuation, measurements are taken at different times and a peakdetection algorithm is used to determine the diastolic point and thesystolic point of the spectral responses at 1206. Fast Fourier transform(FFT) or differential absorption techniques may also be used to isolatethe DC component of each spectral response signal. The various methodsinclude one or more of: Peak & Valley (e.g., peak detection), FFT, anddifferential absorption. Each of the methods require different amountsof computional time which affects overall embedded computing time foreach signal, and therefore can be optimized and selectively validatedwith empirical data through large clinical sample studies.

The I_(AC+DC) and I_(DC) components are then used to compute the Lvalues at 1210. For example, a logarithmic function may be applied tothe ratio of I_(AC+DC) and I_(DC) to obtain an L value for each of thewavelengths L_(λ1−n). Since the respiratory cycle affects the PPGsignals, the L values may be averaged over a respiratory cycle and/orover another predetermined time period (such as over a 1-2 minute timeperiod).

In an embodiment, NO isoforms may be attached in the blood stream to oneor more hemoglobin compounds. The concentration level of the hemoglobincompounds may then need to be accounted for to isolate the concentrationlevel of NO from the hemoglobin compounds. For example, nitric oxide(NO) is found in the blood stream in a gaseous form and also attached tohemoglobin compounds as described herein. Thus, the spectral responsesobtained around 390 nm may include a concentration level of thehemoglobin compounds as well as nitric oxide. The hemoglobin compoundconcentration levels must thus be compensated for to isolate the nitricoxide concentration levels. Multiple wavelengths and absorptioncoefficients for hemoglobin are used to determine a concentration of thehemoglobin compounds at 1214. This process is discussed in more detailherein below. Other methods may also be used to obtain a concentrationlevel of hemoglobin in the arterial blood flow as explained herein. Theconcentration of the hemoglobin compounds is then adjusted from theconcentration level of NO at 1216. The R values are then determined at1218.

To determine a concentration level of NO, a calibration database is usedthat associates R values to concentration levels of NO at 1220. Thecalibration database correlates the R value with an NO concentrationlevel. The calibration database may be generated for a specific patientor may be generated from clinical data of a large sample population. Itis determined that the R values should correlate to similar NOconcentration levels across a large sample population. Thus, thecalibration database may be generated from testing of a large sample ofa general population.

In addition, the R values may vary depending on various factors, such asunderlying skin tissue. For example, the R values may vary for spectralresponses obtained from an abdominal area versus measurements from awrist or finger due to the varying tissue characteristics. Thecalibration database may thus provide different correlations between theR values and NO concentration levels depending on the underlying skintissue characteristics.

The NO concentration level is then obtained at 1224. The NOconcentration level may be expressed as mmol/liter, as a saturationlevel percentage, as a relative level on a scale, etc. In order toremove the hemoglobin concentration(s) from the original PPG signals, amapping function may be created which is constructed through clinicaldata and tissue modeling. For example, known SpO₂ values in the infraredregion and the same signals at the UV side of the spectrum are obtained.Then a linear inversion map can be constructed where the R values areinput into a function and the desired concentration(s) can bedetermined. For example, a curve that correlates R values toconcentration levels (similar to FIG. 33 for SpO₂) may be tabulated. Apolynomial equation with multiple factors can also be used to accountfor different R values to represent the linear inversion map. Thiscorrelation may be derived from validated clinical data.

For example, a regression curve similar to the curve in FIG. 33 thatcorrelates R values and SpO₂ may be generated for each substance basedon clinical data from a large general population. A polynomial may bederived from the curve and used to solve for a concentration level fromthe R value. The polynomial is stored in the calibration database andmay be used rather than using a calibration look-up table or curve.

Embodiment—Determination of a Concentration of Hemoglobin Compounds

The Beer-Lambert theory may be generalized for a multi-wavelength systemto determine a concentration of known hemoglobin species using thefollowing matrix notation:

${\begin{bmatrix}{dA}_{\lambda 1}^{LB} \\\vdots \\{dA}_{\lambda n}^{LB}\end{bmatrix} = {{\begin{bmatrix}{\Delta \; l_{\lambda 1}} & \ldots & 0 \\\vdots & \ddots & \vdots \\0 & \ldots & {\Delta \; l_{\lambda n}}\end{bmatrix}\begin{bmatrix}ɛ_{{\lambda 1},{HbX}_{1}} & \ldots & ɛ_{{\lambda 1},{HbX}_{m}} \\\vdots & \ddots & \vdots \\ɛ_{{\lambda n},{HbX}_{1}} & \ldots & ɛ_{{\lambda m},{HbX}_{m}}\end{bmatrix}} \cdot \begin{bmatrix}{HbX}_{1} \\\vdots \\{HbX}_{m}\end{bmatrix} \cdot {c({Hb})}}},$

wherein

dA_(λ) ^(LB) is a differential absorption within the Beer-Lambert model

ε_(λn1,HbX1) is an extinction coefficient

HbX are hemoglobin fractions

Δlλ is the optical path-length for wavelength λ

c(Hb) is the hemoglobin concentration

This matrix equation for determining hemoglobin concentration levels maybe solved when m is equal or greater than n, e.g., which means that atleast four wavelengths are needed to solve for four hemoglobin species.

FIG. 13 illustrates a schematic block diagram of an exemplary embodimentof a graph 1300 illustrating the extinction coefficients over a range offrequencies for a plurality of hemoglobin species. The hemoglobinspecies include, e.g., Oxyhemoglobin [HbO₂ or OxyHb] 1302,Carboxyhemoglobin [HbCO or CarboxyHb] 1304, Methemoglobin [HbMet orMetHb] 1306, and deoxygenated hemoglobin (DeoxyHb or RHb) 1308. A methodfor determining the relative concentration or composition of hemoglobinspecies included in blood is described in more detail in U.S. Pat. No.6,104,938 issued on Aug. 15, 2000, which is hereby incorporated byreference herein.

A direct calibration method for calculating hemoglobin species may beimplemented by the biosensor 100. Using four wavelengths and applying adirect model for four hemoglobin species in the blood, the followingequation results:

${HbX} = \frac{{a_{1}*{dA}_{1}} + {a_{2}*{dA}_{2}} + {a_{3}*{dA}_{3}} + {a_{4}*{dA}_{4}}}{{b_{1}*{dA}_{1}} + {b_{2}*{dA}_{2}} + {b_{3}*{dA}_{3}} + {b_{4}*{dA}_{4}}}$

wherein

dA_(λ) is the differential absorption signal

a_(n) and b_(n) are calibration coefficients

The calibration coefficients a_(n) and b_(n) may be experimentallydetermined over a large population average. The biosensor 100 mayinclude a calibration database to account for variances in thecalibration coefficients a₁ and b₁ (or extinction coefficients) for thehemoglobin species for various underlying tissue characteristics.

A two-stage statistical calibration and measurement method forperforming PPG measurement of blood analyte concentrations may also beimplemented by the biosensor 100. Concentrations of MetHb, HbO₂, RHb andHbCO are estimated by first estimating a concentration of MetHb (in afirst stage) and subsequently, if the concentration of MetHb is within apredetermined range, then the estimated concentration of MetHb isassumed to be accurate and this estimated concentration of MetHb isutilized as a “known value” in determining the concentrations of theremaining analytes HbO₂, RHb and HbCO (in a second stage). This methodfor determining a concentration of hemoglobin species using a two stagecalibration and analyte measurement method is described in more detailin U.S. Pat. No. 5,891,024 issued on Apr. 6, 1999, which is herebyincorporated by reference herein.

The concentration of the hemoglobin compounds may thus be determined andthen the hemoglobin concentration removed when determining theconcentration level of NO by the biosensor 100. Though several methodsare described herein for obtaining a concentration of hemoglobinanalytes, other methods or processes may be used by the biosensor 100 todetermine the concentration of hemoglobin analytes or otherwiseadjusting the obtained measurements to account for a hemoglobinconcentration when determining the concentration levels of NO in a bloodstream.

Embodiment—Determination of NO Concentration Levels using Shifts inAbsorbance Peaks

In another embodiment, a concentration level of NO may be obtained frommeasuring a characteristic shift in an absorbance peak of hemoglobin.For example, the absorbance peak for methemoglobin shifts from around433 nm to 406 nm in the presence of NO. The advantage of the measurementof NO by monitoring methemoglobin production includes the wideavailability of spectrophotometers, avoidance of sample acidification,and the relative stability of methemoglobin. Furthermore, as the reducedhemoglobin is present from the beginning of an experiment, NO synthesiscan be measured continuously, removing the uncertainty as to when tosample for NO.

FIG. 14 illustrates a schematic block diagram of an exemplary embodimentof a graph 1400 illustrating a shift in absorbance peaks of hemoglobinin the presence of NO. In graph A, the curve 1402 illustrates theabsorbance spectra of reduced hemoglobin. The addition of nitric oxide(NO) shifts the absorbance spectra curve 1404 to a lower wavelength dueto the production of methemoglobin. In graph B, the absorbance spectracurve of reduced hemoglobin 1402 is again illustrated. Endothelial cellsare then added and the absorbance spectra measured again. The curve 1406illustrates that little change occurs in the absorbance spectra curve1402 of reduced hemoglobin in the presence of unstimulated endothelialcells. The curve 1408 illustrates the production of methemoglobin whenthe same dose of endothelial cells was given after stimulation of EDRFsynthesis by the ionophore.

Though the absorbance spectrums shown in the graph 1400 were measuredusing in vitro assays, the biosensor 100 may detect nitric oxide in vivousing PPG techniques by measuring the shift in the absorbance spectracurve of reduced hemoglobin 1402 in tissue and/or arterial blood flow.The absorbance spectra curve 1402 shifts with a peak from around 430 nmto a peak around 411 nm depending on the production of methemoglobin.The greater the degree of the shift of the peak of the curve 1402, thehigher the production of methemoglobin and NO concentration level.Correlations may be determined between the degree of the measured shiftin the absorbance spectra curve 1402 of reduced hemoglobin to an NOconcentration level. The correlations may be determined from a largesample population or for a particular patient and stored in acalibration database. The biosensor 100 may thus obtain an NOconcentration level by measuring the shift of the absorbance spectracurve 1402 of reduced hemoglobin.

FIG. 15 illustrates a schematic block diagram of an exemplary embodimentof a graph 1500 illustrating a shift in absorbance peaks of oxygenatedand deoxygenated hemoglobin (HB) in the presence of nitric oxide NO. Theabsorbance spectra curve 1502 of deoxygenated HB has a peak of around430 nm. After a one minute time period of exposure to a nitric oxidemixture, the absorbance spectra curve 1504 of deoxygenated HB shifted toa peak of around 405 nm. In addition, the absorbance spectra curve 1506of oxygenated HB has a peak around 421 nm. After a twenty minute timeperiod of exposure to a nitric oxide mixture, the absorbance spectracurve 1508 of oxygenated HB shifted to a peak of around 393 nm. TheDeoxygenated Hb has an absorption peak at 430 nm (1502) and in thepresence of NO has a peak shift to 405 nm (1504). The Oxygenated Hb hasabsorption peak at 421 nm (1506) in presence of NO has peak shift to 393nm (1508).

Though the absorbance spectrums shown in the graph 1500 were measuredusing in vitro assays, the biosensor 100 may obtain an NO concentrationlevel by measuring the shift of the absorbance spectra curve 1502 ofdeoxygenated hemoglobin and/or by measuring the shift of the absorbancespectra curve 1506 of oxygenated hemoglobin in vivo. The biosensor 100may then access a calibration database that correlates the measuredshift in the absorbance spectra curve 1502 of deoxygenated hemoglobin toan NO concentration level. Similarly, the biosensor may access acalibration database that correlates the measured shift in theabsorbance spectra curve 1506 of oxygenated hemoglobin to an NOconcentration level.

FIG. 16 illustrates a logical flow diagram of an exemplary embodiment ofa method 1600 for measuring NO concentration levels in vivo using shiftsin absorbance spectra. The biosensor 100 may obtain a concentration ofNO by measuring shifts in absorbance spectra of one or more substancesthat interact with NO. For example, the one or more substances mayinclude oxygenated and deoxygenated hemoglobin (HB). The PPG circuit 110detects a spectral response at a plurality of wavelengths of the one ormore substances that interact with NO at 1602. The biosensor 100determines the relative shift in the absorbance spectra for thesubstance at 1604. For example, the biosensor 100 may measure theabsorbance spectra curve 1502 of deoxygenated HB and determine itsrelative shift or peak between the range of approximately 430 nm and 405nm. In another example, the biosensor 100 may measure the absorbancespectra curve of oxygenated HB and determine its relative shift or peakbetween 421 nm and 393 nm.

The biosensor 100 accesses a calibration database that correlates therelative shift in the absorbance spectra of the substance with aconcentration level of NO at 1606. The biosensor 100 may thus obtain anNO concentration level using calibration database and the measuredrelative shift in absorbance spectra of the spectrum at 1608.

FIG. 17 illustrates a logical flow diagram of an exemplary embodiment ofa method 1700 for measuring NO concentration levels using one or moremeasurement techniques. In an embodiment, the biosensor 100 isconfigured to determine a concentration level of NO in vivo using PPGtechnology and one or more measurement techniques described herein. Forexample, the biosensor 100 may determine an R value at L₃₉₀/L₉₄₀ at 1702and accessing a calibration database that maps the R value to an NOconcentration level. In another example, the biosensor may determine NOconcentration level using absorption spectrum over a plurality ofwavelengths and subtract or compensate for hemoglobin concentrations at1704. In another example, the biosensor 100 may determine the relativeshift in the absorbance spectra for the substance and access acalibration database that correlates the relative shift in theabsorbance spectra of the substance with a concentration level of NO at1706.

The biosensor 100 may use a plurality of these methods to determine aplurality of values for the concentration level of NO at 1708. Thebiosensor 100 may determine a final concentration value using theplurality of values. For example, the biosensor 100 may average thevalues, obtain a mean of the values, etc.

FIG. 18 illustrates a logical flow diagram of an embodiment of a method1800 for monitoring NO measurements in vivo. In 1802, a baseline of anNO measurement in blood vessels is obtained. For example, the NOmeasurement may be the R value at Lλ1=390 nm and Lλ2=940 nm. In anotherembodiment, the NO measurement may be a SpNO measurement of aconcentration level of NO in the blood. In another embodiment, the NOmeasurement may be obtained using a value of L_(λ1)=380 nm-400 nm andLλ2≧660 nm.

The biosensor 100 displays the baseline NO measurement in 1804 and thennon-invasively and continuously monitors the NO measurement in bloodvessels in 1806. For example, the biosensor 100 may obtain the NOmeasurement at least once per minute or more frequently, such as every10 seconds or 30 seconds, and continues to display the NO concentrationlevel. The biosensor 100 may average the obtained L values and/or Rvalues over one or more respiratory cycles or over a predetermined timeperiod (such as one minute) to obtain the NO concentration level.

One or more of the NO measurements (Such as Lλ1=390 nm, R value, NOconcentration level) may be compared to predetermined thresholds at1808. For example, normal ranges of the NO measurement from the baselinemeasurement are determined. Depending on the comparison, one or morehealth risks may be determined. For example, diabetic risk or potentialcarbon monoxide poisoning or septic risk may be determined. The one ormore health risks or a general warning of abnormal NO measurements maythen be displayed at 1810. In addition, the NO measurements or warningsmay be transmitted by the biosensor either wirelessly or over a wiredconnection over a LAN or WAN to a user device or monitoring station orphysician's office or other third party in 1812. For example, thewarning may be transmitted to a nursing station, an emergency alertservice or physician's office to provide emergency services to thepatient.

Embodiment—Adjustments in response to Positioning of the Biosensor

FIG. 19 illustrates a logical flow diagram of an embodiment of a method1900 for adjusting operation of the biosensor 100 in response to aposition of the biosensor 100. The biosensor 100 may be positioned overdifferent parts of a patient that exhibit different underlying tissuecharacteristics. For example, the biosensor 100 may be positioned on orattached to various areas of the body, e.g. a hand, a wrist, an arm,forehead, chest, abdominal area, ear lobe, fingertip or other area ofthe skin or body or living tissue. The characteristics of underlyingtissue vary depending on the area of the body, e.g. the underlyingtissue of an abdominal area has different characteristics than theunderlying tissue at a wrist. The operation of the biosensor 100 mayneed to be adjusted in response to its positioning due to such varyingcharacteristics of the underlying tissue.

The biosensor 100 is configured to obtain position information on apatient at 1902. The position information may be input from a userinterface. In another aspect, the biosensor 100 may determine its ownpositioning. For example, the PPG circuit 110 may be configured todetect characteristics of underlying tissue. The biosensor 100 thencorrelates the detected characteristics of the underlying tissue withknown or predetermined characteristics of underlying tissue (e.g.measured from an abdominal area, wrist, forearm, leg, etc.) to determineits positioning. Information of amount and types of movement from anactivity monitoring circuit implemented within the biosensor 100 mayalso be used in the determination of position.

In response to the determined position and/or detected characteristicsof the underlying tissue, the operation of the biosensor 100 is adjustedat 1904. For example, the biosensor 100 may adjust operation of the PPGcircuit 110 at 1906. The article, “Optical Properties of BiologicalTissues: A Review,” by Steven L. Jacques, Phys. Med. Biol. 58 (2013),which is hereby incorporated by reference herein, describeswavelength-dependent behavior of scattering and absorption of differenttissues. The PPG circuit 110 may adjust a power of the LEDs or afrequency or wavelength of the LEDs based on the underlying tissue. Thebiosensor 100 may adjust processing of the data at 1908. For example, anabsorption coefficient may be adjusted when determining a concentrationlevel of a substance based on Beer-Lambert principles due to thecharacteristics of the underlying tissue.

In addition, the calibrations utilized by the biosensor 100 may varydepending on the positioning of the biosensor at 1908. For example, thecalibration database may include different table or other correlationsbetween R values and NO concentration level depending on position of thebiosensor. Due to the different density of tissue and vessels, the Rvalue obtained from measurements over an abdominal area may be differentthan measurements over a wrist or forehead. The calibration database maythus include different correlations of the R value and NO concentrationlevel depending on the underlying tissue. Other adjustments may also beimplemented by the biosensor 100 depending on predetermined or measuredcharacteristics of the underlying tissue.

The biosensor 100 is thus configured to obtain position information andperform adjustments to its operation in response to the positioninformation.

Embodiment—EMR Network

FIG. 20 illustrates a schematic block diagram of an embodiment of anexemplary network 2000 in which the the biosensor 100 described hereinmay operate. The exemplary network 2000 may include a combination of oneor more networks that are communicatively coupled, e.g., such as a widearea network (WAN) 2002, a wired local area network (LAN) 2004, awireless local area network (WLAN) 2006, or a wireless wide area network(WAN) 2008. The wireless WAN 1228 may include, for example, a 3G or 4Gcellular network, a GSM network, a WIMAX network, an EDGE network, aGERAN network, etc. or a satellite network or a combination thereof. TheWAN 1222 includes the Internet, service provider network, other type ofWAN, or a combination of one or more thereof. The LAN 2004 and the WLANs2006 may operate inside a home 2016 or enterprise environment, such as aphysician's office 2018, pharmacy 2020 or hospital 2022 or othercaregiver.

The biosensor 100 may communicate to one or more user devices 2010, suchas a smart phone, laptop, desktop, smart tablet, smart watch, or anyother processing device. In one aspect, the user device 2010 orbiosensor 100 may communicate the patient's vitals to a local or remotemonitoring station 2012 of a caregiver or physician.

One or more biosensor 100s are communicatively coupled to an EMRapplication server 2030 through one or more user devices 2010 and/ornetworks in the EMR network 2000. The EMR server 2030 includes a networkinterface card (NIC) 2032, a server processing circuit 2034, a servermemory device 2036 and EMR server application 2038. The networkinterface circuit (NIC) 2032 includes an interface for wireless and/orwired network communications with one or more of the exemplary networksin the EMR network 2000. The network interface circuit 2032 may alsoinclude authentication capability that provides authentication prior toallowing access to some or all of the resources of the EMR applicationserver 2030. The network interface circuit 2032 may also includefirewall, gateway and proxy server functions.

The EMR application server 2030 also includes a server processingcircuit 2034 and a memory device 2036. For example, the memory device2036 is a non-transitory, processor readable medium that storesinstructions which when executed by the server processing circuit 2034,causes the server processing circuit 2034 to perform one or morefunctions described herein. In an embodiment, the memory device 2036stores a patient EMR 408 that includes biosensor data and historicaldata of a patient associated with the patient ID 406.

The EMR application server 2030 includes an EMR server application 2038.The EMR server application 2038 is operable to communicate with thebiosensors 100 and/or user devices 2010 and monitoring stations 2012.The EMR server application 2038 may be a web-based application supportedby the EMR application server 2030. For example, the EMR applicationserver 2030 may be a web server and support the EMR server application2038 via a website. In another embodiment, the EMR server application2038 is a stand-alone application that is downloaded to the user devices2010 by the EMR application server 2030 and is operable on the userdevices 2010 without access to the EMR application server 2030 or onlyneeds to accesses the EMR application server 2030 for additionalinformation and updates.

In use, the biosensors 100 may communicate patient's biosensor data(such as NO concentration level, heart rate, temperature, respiratorycycle, etc.) to the EMR application server 2030. A biosensor 100 may beprogrammed with a patient identification 406 that is associated with apatient's EMR 408. The biosensor 100 measures the patient's vitals, suchas heart rate, pulse, blood oxygen levels, NO levels, etc. and may alsocommunicate information to a drug delivery system to administermedications to the patient. The biosensor 100 is configured to transmitthe patient vitals to the EMR application server 2030. The EMR serverapplication 2038 updates an EMR 408 associated with the patientidentification 406 with the patient vitals.

The EMR application server 2030 may also be operable to communicate witha physician's office 2018 or pharmacy 2016 or other third party healthcare provider over the EMR network 2000 to provide biosensor data andreceive instructions on dosages of medication. For example, the EMRserver application 2038 may transmit NO level information, heart rateinformation or pulse rate information or medication dosages or bloodconcentration levels of one or more relevant substances to a physician'soffice 2018. The EMR server application 2038 may also be configured toprovide medical alerts to notify a user, physician or other caregiverwhen vitals are critical or reach a certain predetermined threshold.

The EMR server application 2030 may also receive instructions from aphysician's office 2018, pharmacy 2016 or hospital 2022 or othercaregiver regarding a prescription or administration of a dosage ofmedication. The EMR server application 2038 may then transmit theinstructions to the biosensor 100. The instructions may include a dosageamount, rate of administration or frequency of dosages of a medication.The biosensor 100 may then control a drug delivery system to administerthe medication automatically as per the transmitted instructions.

Embodiment—Interoperability of Biosensors and Other Devices

FIG. 21 illustrates a schematic block diagram of an embodiment of anetwork illustrating interoperability of a plurality of biosensors 100.A plurality of biosensors 100 may interface with a patient andcommunicate with one or more of the other biosensor 100s. The biosensors100 may communicate directly or communicate indirectly through a WLAN orother type of network as illustrated in the EMR network 2000 of FIG. 20.For example, a first biosensor 100a may include a PPG circuit 110configured to detect a NO concentration level. For better detection, thebiosensor 100 a is positioned on a wrist. A second biosensor 100 b maybe positioned on a chest area of the patient 2100. In use, the firstbiosensor 100 a continuously monitors NO concentration levels and thencommunicates either directly or indirectly the detected levels to theuser device 2010 or network 2000 or second biosensor 100 b or to one ormore medical devices 2102 a-b. For example, the first biosensor 100a maytransmit NO concentration levels to a medical device 2102 a thatdelivers medicine to the patient 2100. The second biosensor 100 b maydetect heart rate or respiratory cycle and communicates either directlyor indirectly the detected levels to the user device 2010 or network2000 or first biosensor 100 a or medical devices 2102 a-b.

In another example, a plurality of biosensors 100, such as the firstbiosensor 100 a and the second biosensor 100 b, may be positioned on apatient to monitor an ECG of the patient. The biosensors 100 maycommunicate the ECG measurements directly or indirectly to each other togenerate an electrocardiogram. The electrocardiogram is transmitted toan EMR application server 2030 or monitoring station 2012 or to a userdevice 2010. Based on the electrocardiogram, a doctor or user mayprovide instructions to one of the medical devices 2102 a-b. Forexample, one of the medical devices 2102 a-b may include a pacemaker.

FIG. 22A and FIG. 22B illustrate an embodiment of a typical waveform ofa PPG signal 2200 reflecting an arterial pressure waveform. In FIG. 22A,the PPG signal 2200 includes characteristic parameters such as systolicpeak 2202 with an amplitude x and a diastolic peak 2204 of amplitude y.A width 2208 of the pulse is measured at a half the amplitude x. Adicrotic notch 2206 is also typically exhibited. The dicrotic notch 2206is a secondary upstroke in the descending part of the arterial pressurepulse curve corresponding to the transient increase in aortic pressureupon closure of the aortic valve. It may be used as a marker for the endof the_systole period of the cardiac cycle. FIG. 22B illustrates a firstPPG signal 2200 a and a second PPG signal 2200 b. The distance betweenthe systolic peak of the first PPG signal 2200 a and the second PPGsignal 2200 b is known as the peak to peak interval 2210. A pulseinterval 2212 is the distance between the beginning of one pulse to thebeginning of the next pulse.

Embodiment—Clinical Data

Clinical data obtained using an embodiment of the biosensor 100 is nowdescribed herein. The biosensor 100 was used to monitor concentrationlevels or indicators of Nitric Oxide in the blood flow of a patient inclinical trials over a measurement time period.

FIG. 23 illustrates a schematic drawing of an exemplary embodiment ofresults of a spectral response 2300 obtained using an embodiment of thebiosensor 100 from a first patient. The spectral response 2300 wasobtained at a wavelength of around 395 nm and is illustrated for a timeperiod of about 40 seconds.

FIG. 24 illustrates a schematic drawing of an exemplary embodiment ofresults of a filtered spectral response 2400. The spectral response 2300in FIG. 23 is filtered using digital signal processing techniques by thebiosensor 100 to eliminate noise and background interference to obtainthe filtered spectral response 2400. A first respiration cycle 2402 anda second respiration cycle 2404 may be seen in the slow fluctuation ofthe filtered spectral response 2400. Due to this fluctuation overrespiratory cycles, the obtained L values are averaged over a pluralityof respiratory cycles or over a predetermined time period such as 1-2minutes.

FIG. 25 illustrates a schematic drawing of an exemplary embodiment ofresults of an I_(DC) signal 2500 generated using the filtered spectralresponse 2400. A low pass filter (such as a 5 Hz low pass filter) isapplied to the filtered spectral response 2400 (I_(AC+DC)) to obtain theDC component of the spectral response I_(DC).

FIG. 26 illustrates a schematic drawing of an exemplary embodiment ofresults of an I_(AC) signal 2600. The I_(AC) signal 2600 is generatedfrom the the filtered spectral response 2400 and the signal I_(DC 2500.)The AC component is the fluctuation due to the pulsatile expansion ofthe arteriolar bed as the volume of arterial blood increases. In orderto measure the AC fluctuation, measurements are taken at different timesand a peak detection algorithm is used to determine the diastolic pointand the systolic point of the filtered spectral response. Rather thanusing a low pass filter, fast Fourier transform or other functions mayalso be used to isolate the DC component of the filtered spectralresponse to obtain I_(AC).

FIG. 27 illustrates a schematic drawing of an exemplary embodiment ofresults of L values 2700 obtained over a time period. The filteredspectral response I_(AC+DC) 2400 and I_(DC) signal 2500 components areused to compute L values 2700. A logarithmic function is applied to theratio of the signal IAC+DC and the signal IDC:

$L_{395} = {{Log}\; 10\left( \frac{{IAC} + {DC}}{IDC} \right)}$

The L values 2700 fluctuate between 0.005 and 0.045 over the four secondtime period illustrated in the graph.

FIG. 28 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged L values 2800. The L values are affected by therespiratory cycle as previously described. Thus, the L values 2700 shownin FIG. 27 are averaged over two or more respiratory cycles.Alternatively, the L values 2700 may be averaged over a predeterminedtime period (such as a 1-2 minute time period). As shown in FIG. 28, theaveraged L values 2800 fluctuate between 0.2 and 0.3 over a three minutetime period.

FIG. 29 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged R values 2900. A ratio R of the L_(395 nm) valuesand L_(940 nm) are obtained from:

${{Ratio}\mspace{14mu} R} = \frac{L395}{L\; 940}$

The averaged R values 2900 may be obtained from averaging the Ratio Rover a predetermined time period or may be calculated from the averagedL values. As shown in FIG. 29, the averaged R values 2900 fluctuatebetween 1.68 and 1.58 over a three minute time period.

FIG. 30 illustrates a schematic drawing of an exemplary embodiment ofresults of R values 3000 determined using a plurality of methods. The Rvalues 3000 corresponding to the wavelengths of 395 nm/940 nm isdetermined using three methods. The R Peak Valley curve 3002 isdetermined using the Ratio

$R = \frac{L395}{L\; 940}$

as described hereinabove. The R FFT curve 3004 is determined using FFTtechniques. The R differential absorption curve 3008 is determined usingthe shift in absorbance spectra as described hereinabove with respect toFIGS. 14-16. As seen in FIG. 30, the determination of the R values usingthe three methods provides similar results, especially when averagedover a period of time. A mean or average of the R values 3002, 3004 and3008 may be calculated to obtain a final R value or one of the methodsmay be preferred depending on the positioning of the biosensor orunderlying tissue characteristics.

FIG. 31 illustrates a schematic drawing of an exemplary embodiment ofresults of R values 3100 for a plurality of wavelength ratios. The Rvalues for 395 nm/940 nm 3106, the R values for 470 nm/940 nm 3104 andthe R values for 660 nm/940 nm 3106 are shown over a time period ofabout 4 seconds.

FIG. 32 illustrates a schematic drawing of an exemplary embodiment ofresults of averaged R values 3200 for a plurality of wavelength ratios.The averaged R values for 395 nm/940 nm 3206, the averaged R values for470 nm/940 nm 3204 and the averaged R values for 660 nm/940 nm 3206 areshown over a time period of about 4 minutes.

FIG. 33 illustrates a schematic drawing of an exemplary embodiment of acalibration curve 3300 for correlating oxygen saturation levels (SpO₂)with R values. For example, the R values may be obtained forL_(660 nm)/L_(940 nm). The calibration curve 3300 may be included aspart of the calibration database for the biosensor 100. In anembodiment, the biosensor 100 may use the 660 nm wavelength to determineSpO2 levels, e.g. rather than IR wavelength range.

From the clinical trials, the L₃₉₀values are measuring NO levels in thearterial blood flow. The R value for L₃₉₀/L_(940 nm) may thus be used toprovide NO concentration levels in the pulsating arterial blood flow.From the clinical trials, it seems that the NO levels are reflected inthe R values obtained from L_(39 nm)/L_(940 nm). The NO concentrationlevel may be obtained from the R values and a calibration database thatcorrelates the R value with known concentration level of NO for thepatient or for a large general population.

In other embodiments, rather than L_(λ1)=390nm, the L value may bemeasured at wavelengths in a range around 390 nm such as from 400 nm to380 nm, e.g., as seen in the graphs wherein L_(λ1)=395 nm is used toobtain a concentration level of NO. In addition, L_(λ2) may be obtainedat any wavelength at approximately 660 nm or above. Thus, R obtained atapproximately Lλ1=380 nm-400 nm and Lλ2≧660 nm may also be used todetermine concentration levels of NO.

FIG. 34A illustrates a perspective view of an exemplary embodiment of abiosensor 100 with PPG circuit 110. In this embodiment, the biosensor100 is implemented with the adjustable band 200. The adjustable band 200may be configured to fit around a wrist, arm, leg, ankle, etc. A USB orother port 206 may be implemented to transmit data to and from thebiosensor 100. The biosensor 100 may also include a wirelesstransceiver.

FIG. 34B illustrates a schematic block drawing of an exemplaryembodiment of the PPG circuit 110 in more detail. In this embodiment,the PPG circuit 110 includes a first photodetector 3406 a and a secondphotodetector 3406 b. A first set of light sources, LEDs 3400 a-n are ona first side of the first photodetector 3406. A second set of lightsources, LEDs 3402 a-n are on a second side of the second photodetector3406 b. A third set of light sources, LEDs 3410 a-n, are arrangedbetween the first photodetector 3406 a and the second photodetector 3406b. In an embodiment, the third set of light sources emits light in theUV range. For example, the UV LEDs 3410 a-n emit light at a plurality ofdifferent wavelengths in the UV range. The first set of LEDs 3400 andthe second set of LEDs 3402 may each include an LED in the IR range andvisible light range.

FIG. 35 illustrates a logical flow diagram of an exemplary embodiment ofa method 3500 for determining heart rate. A first spectral response isobtained from the first photodetector and a second spectral response isdetected from the second photodetector using a high speed sample rate,such as 400 Hz. The two different photodetectors detect a small phasedifference in subsequent spectral responses due to movement of thearterial pressure wave through the arteries. The phase difference may becorrelated to a pulse rate. In general, the shorter the phasedifference, the higher the pulse rate. A calibration table or curve maybe generated to correlate the phase difference to the pulse rate andstored in the calibration database for the biosensor 100.

A first spectral response is obtained from the first photodetector and asecond spectral response is obtained from the second photodetector at3502. A phase difference is obtained between the arterial pressure wavein the first spectral response and the second spectral response at 3504.A pulse rate is then obtained using a calibration database at 3506.

FIG. 36 illustrates a logical flow diagram of an exemplary embodiment ofa method 3600 for determining a cardiac cycle. In an embodiment, aspectral response of a wavelength in the UV range of 400 nm or awavelength of 500 nm or less may be used to determine a cardiac cyclesignal. It has been determined in unexpected results that a cardiaccycle signal may be more easily detected using a wavelength of 500 nm orless over certain types of skin tissue, e.g., especially in abdominalarea, upper arm, thigh, calf or other skin areas including fatty tissueor deposits wherein blood vessels may not be prevalent or near the skinsurface. In an embodiment, the biosensor 100 obtains a position on theskin surface at 3602 or determines the underlying skin tissues includesa predetermined characteristic, e.g. fatty tissue or deposits whereinmajor arterial blood vessels may not be prevalent or near the skinsurface at 3604. The biosensor 100 then transmits a wavelength in the UVrange (e.g., 400 nm or less) or a wavelength of 500 nm or less directedat the skin tissue. The biosensor 100 detects the spectral response at3606 and obtains a signal indicating a cardiac cycle from the spectralresponse at 3608. Heart rate and other information may be more easilyobtained from the spectral response of a wavelength in the UV range or awavelength of 500 nm or less due to the deeper penetration of thesewavelengths in the skin tissue.

FIG. 37 illustrates a logical flow diagram of an exemplary embodiment ofa method 3700 for determining an absorption rate of a substance. In anembodiment, the PPG circuit 110 includes one or more light sourcesconfigured to emit a plurality of different wavelengths of UV light. TheUV light has different ability to penetrate skin tissue depending on itswavelength.

The higher the UV wavelength, the less the penetration depth in the skintissue. Thus, by projecting a plurality of different UV wavelengths atthe skin tissue, the biosensor 100 may determine absorption rate of asubstance into the skin tissue.

The biosensor 100 obtains the spectral responses from a plurality ofdifferent wavelengths, wherein the different wavelengths have varyingpenetration depths of skin tissue at 3702. The absorption spectra of asubstance at different depths in the skin tissue may be determined fromthe different spectral responses. The biosensor 100 determines thedifference in absorption spectra of a substance from the plurality ofdifferent spectral responses at 3704. The biosensor 100 may continue toobtain and monitor the difference in absorption spectra of a substanceat different depths in the skin tissue over a period of time. Thebiosensor 100 may then obtain an absorption rate of the substance intothe skin tissue from the difference in absorption spectra of a substanceat the plurality of different wavelengths at 3706.

FIG. 38 illustrates a schematic block diagram of an embodiment of acalibration database 3800. The calibration database 3800 includes one ormore calibration tables 3802, calibration curves 3804 or calibrationfunctions 3806 for correlating obtained values to concentration levelsof NO. The concentration level of NO may be expressed in the calibrationtables 3802 as units of mmol/liter, as a saturation level percentage(SpNO %), as a relative level on a scale (e.g., 0-10), etc.

The calibration tables 3802 include one or more calibration tables forone or more underlying skin tissue type 3808 a-n. In one aspect, thecalibration tables 3808 correlate an R value to a concentration level ofNO for a plurality of underlying skin tissue types. For example, a firstset of tables 3808 a-n may correlate R values to NO concentration levelsfor a wrist area, a second table for an abdominal area, a third tablefor a forehead area, etc.

In another aspect, a set of calibration tables 3810 a-n correlate anabsorption spectra shift to a concentration level of NO for a pluralityof underlying skin tissue types. For example, a first table 3810 maycorrelate a degree of absorption spectra shift of oxygenated hemoglobinto NO concentration levels for a wrist area, a second table 3810 for anabdominal area, a third table 3810 for a forehead area, etc. The degreeof shift may be for the peak of the absorbance spectra curve ofoxygenated hemoglobin from around 421 nm. In another example, the set oftable 3810 s may correlate a degree of absorption spectra shift ofdeoxygenated hemoglobin to NO concentration levels for a wrist area, asecond table for an abdominal area, a third table for a forehead area,etc. The degree of shift may be for the peak of the absorbance spectracurve of deoxygenated hemoglobin from around 430 nm.

The calibration database 3802 may also include a set of calibrationcurves 3804 for a plurality of underlying skin tissue types. Thecalibration curves may correlate R values or degree of shifts toconcentration levels of NO.

The calibration database 3802 may also include calibration functions3806. The calibration functions 3806 may be derived (e.g., usingregressive functions) from the correlation data from the calibrationcurves 3804 or the calibration tables 3802. The calibration functions3806 may correlate R values or degree of shifts to concentration levelsof NO for a plurality of underlying skin tissue types.

Based on these unexpected results, in one aspect, the biosensor 100 maydetermine non-invasively an indicator of the NO concentration level invivo of a patient. The biosensor 100 detects a plurality of spectralresponses from light directed at skin tissue of a patient. The spectralresponses are used to determine an R value from L_(λ1)/L_(λ2), whereinλ1 has a high absorption coefficient for NO and is in a range from 370nm to 410 nm and preferably in a range from 390-395 nm. The secondwavelength λ2 has a lower absorption coefficient for NO than the firstwavelength λ1 and may be in a range equal to or greater than 660 nm.

In the clinical trials herein, the R value was in a range of 0-8. Otherranges, weights or functions derived using the R value described hereinmay be implemented that changes the numerical value of the R valuesdescribed herein or the range of the R values described herein. Acalibration database may then correlate the R value to a concentrationlevel of NO.

The R value may be non-invasively and quickly and easily obtained usingthe biosensor 100 in a physician's office or other clinical setting orat home. In one aspect, the R value may be used to determine whetherfurther testing for health conditions need to be performed. For example,upon detection of a low R value of less than 1, a clinician may thendetermine to perform further testing and monitoring, e.g. for diabetes.

A wide range of conditions require frequent monitoring such as diabetes,hypotension, hypertension, cardiac arrest, carbon monoxide poisoning,seizures, strokes, respiratory arrest, dyspnea, and sepsis. Thebiosensor 100 may be used to continuously monitor patients with one ormore of these conditions. The biosensor 100 may monitor NO levels, aswell as other patient vitals such as heart rate, blood pressure, and/orSpO2.

Embodiment—Measurements of Other Substances

Using similar principles described herein, the biosensor 100 may measureconcentration levels or indicators of other substances in pulsatingblood flow. For example, absorption coefficients for one or morefrequencies that have an intensity level responsive to concentrationlevel of substance may be determined. The biosensor 100 may then detectthe substance at the determined one or more frequencies as describedherein and determine the concentration levels using the Beer-Lambertprinciples and the absorption coefficients. The L values and R valuesmay be calculated based on the obtained spectral response. In oneaspect, the biosensor 100 may detect various electrolyte concentrationlevels or blood analyte levels, such as bilirubin and sodium andpotassium. In another aspect, the biosensor 100 may detect sodium NACLconcentration levels in the arterial blood flow to determinedehydration. In yet another aspect, the biosensor 100 may be configuredto detect proteins or abnormal cells or other elements or compoundsassociated with cancer. In another aspect, the PPG sensor may detectwhite blood cell counts. In another aspect, the biosensor may detectblood alcohol levels.

For example, the biosensor 100 may also determine alcohol levels in theblood using wavelengths at approximately 390 nm and/or 468 nm. Inanother embodiment, an R468,940 value for at least L468 nm/L940 nm maybe used as a liver enzyme indicator, e.g. P450 enzyme indicator. Inanother embodiment, an R592,940 value for at least L592 nm/L940 nm maybe used as a digestive indicator to measure digestive responses, such asphase 1 and phase 2 digestive stages. In another aspect, the biosensor100 may detect white blood cell counts or concentration levels inarterial blood flow using similar PPG techniques. The presence of whiteblood cell counts may indicate the presence of infection.

In another aspect, abnormal cells or proteins or compounds that arepresent or have higher concentrations in the blood with persons havingcancer, may be detected using similar PPG techniques described herein atone or more other wavelengths. Thus, cancer risk may then be obtainedthrough non-invasive testing by the biosensor 100. Since the biosensor100 may operate in multiple frequencies, various health monitoring testsmay be performed concurrently.

One or more embodiments have been described herein for the non-invasiveand continuous biosensor 100. Due to its compact form factor, thebiosensor 100 may be configured for measurements on various skinsurfaces of a patient, including on a forehead, arm, wrist, abdominalarea, chest, leg, ear lobe, finger, toe, ear canal, etc. The biosensorincludes one or more sensors for detecting biosensor data, such as apatient's vitals, activity levels, or concentrations of substances inthe blood flow of the patient. In particular, the PPG sensor isconfigured to monitor concentration levels or indicators of one or moresubstances in the blood flow of the patient. In one aspect, the PPGsensor may non-invasively and continuously detect nitric oxide (NO)levels in pulsatile arterial blood flow.

In one or more aspects herein, a processing module or circuit includesat least one processing device, such as a microprocessor,micro-controller, digital signal processor, microcomputer, centralprocessing unit, field programmable gate array, programmable logicdevice, state machine, logic circuitry, analog circuitry, digitalcircuitry, and/or any device that manipulates signals (analog and/ordigital) based on hard coding of the circuitry and/or operationalinstructions. A memory is a non-transitory memory device and may be aninternal memory or an external memory, and the memory may be a singlememory device or a plurality of memory devices. The memory may be aread-only memory, random access memory, volatile memory, non-volatilememory, static memory, dynamic memory, flash memory, cache memory,and/or any non-transitory memory device that stores digital information.

As may be used herein, the term “operable to” or “configurable to”indicates that an element includes one or more of circuits,instructions, modules, data, input(s), output(s), etc., to perform oneor more of the described or necessary corresponding functions and mayfurther include inferred coupling to one or more other items to performthe described or necessary corresponding functions. As may also be usedherein, the term(s) “coupled”, “coupled to”, “connected to” and/or“connecting” or “interconnecting” includes direct connection or linkbetween nodes/devices and/or indirect connection between nodes/devicesvia an intervening item (e.g., an item includes, but is not limited to,a component, an element, a circuit, a module, a node, device, networkelement, etc.). As may further be used herein, inferred connections(i.e., where one element is connected to another element by inference)includes direct and indirect connection between two items in the samemanner as “connected to”.

As may be used herein, the terms “substantially” and “approximately”provides an industry-accepted tolerance for its corresponding termand/or relativity between items. Such an industry-accepted toleranceranges from less than one percent to fifty percent and corresponds to,but is not limited to, frequencies, wavelengths, component values,integrated circuit process variations, temperature variations, rise andfall times, and/or thermal noise. Such relativity between items rangesfrom a difference of a few percent to magnitude differences.

Note that the aspects of the present disclosure may be described hereinas a process that is depicted as a schematic, a flowchart, a flowdiagram, a structure diagram, or a block diagram. Although a flowchartmay describe the operations as a sequential process, many of theoperations can be performed in parallel or concurrently. In addition,the order of the operations may be re-arranged. A process is terminatedwhen its operations are completed. A process may correspond to a method,a function, a procedure, a subroutine, a subprogram, etc. When a processcorresponds to a function, its termination corresponds to a return ofthe function to the calling function or the main function.

The various features of the disclosure described herein can beimplemented in different systems and devices without departing from thedisclosure. It should be noted that the foregoing aspects of thedisclosure are merely examples and are not to be construed as limitingthe disclosure. The description of the aspects of the present disclosureis intended to be illustrative, and not to limit the scope of theclaims. As such, the present teachings can be readily applied to othertypes of apparatuses and many alternatives, modifications, andvariations will be apparent to those skilled in the art.

In the foregoing specification, certain representative aspects of theinvention have been described with reference to specific examples.Various modifications and changes may be made, however, withoutdeparting from the scope of the present invention as set forth in theclaims. The specification and figures are illustrative, rather thanrestrictive, and modifications are intended to be included within thescope of the present invention. Accordingly, the scope of the inventionshould be determined by the claims and their legal equivalents ratherthan by merely the examples described. For example, the componentsand/or elements recited in any apparatus claims may be assembled orotherwise operationally configured in a variety of permutations and areaccordingly not limited to the specific configuration recited in theclaims.

Furthermore, certain benefits, other advantages and solutions toproblems have been described above with regard to particularembodiments; however, any benefit, advantage, solution to a problem, orany element that may cause any particular benefit, advantage, orsolution to occur or to become more pronounced are not to be construedas critical, required, or essential features or components of any or allthe claims.

As used herein, the terms “comprise,” “comprises,” “comprising,”“having,” “including,” “includes” or any variation thereof, are intendedto reference a nonexclusive inclusion, such that a process, method,article, composition or apparatus that comprises a list of elements doesnot include only those elements recited, but may also include otherelements not expressly listed or inherent to such process, method,article, composition, or apparatus. Other combinations and/ormodifications of the above-described structures, arrangements,applications, proportions, elements, materials, or components used inthe practice of the present invention, in addition to those notspecifically recited, may be varied or otherwise particularly adapted tospecific environments, manufacturing specifications, design parameters,or other operating requirements without departing from the generalprinciples of the same.

Moreover, reference to an element in the singular is not intended tomean “one and only one” unless specifically so stated, but rather “oneor more.” Unless specifically stated otherwise, the term “some” refersto one or more. All structural and functional equivalents to theelements of the various aspects described throughout this disclosurethat are known or later come to be known to those of ordinary skill inthe art are expressly incorporated herein by reference and are intendedto be encompassed by the claims. Moreover, nothing disclosed herein isintended to be dedicated to the public regardless of whether suchdisclosure is explicitly recited in the claims. No claim element isintended to be construed under the provisions of 35 U.S.C. §112(f) as a“means-plus-function” type element, unless the element is expresslyrecited using the phrase “means for” or, in the case of a method claim,the element is recited using the phrase “step for.”

1. A biosensor for monitoring nitric oxide (NO) of a patient in vivo,comprising: a PPG circuit configured to: generate at least a firstspectral response for light reflected around a first wavelength fromskin tissue of the patient; generate at least a second spectral responsefor light reflected around a second wavelength from the skin tissue ofthe patient; a processing circuit configured to: obtain a value L_(λ1)using the first spectral response, wherein the value L_(λ1) isolates thefirst spectral response due to pulsating arterial blood flow; obtain avalue L_(λ2) using the second spectral response, wherein the valueL_(λ2) isolates the second spectral response due to pulsating arterialblood flow; obtain a value R_(λ1, λ2) from a ratio of the value L_(λ1)and the value L_(λ2); and obtain a concentration level of nitric oxideusing the value R_(λ1, λ2) and a calibration database, wherein thecalibration database is used to correlate the value R_(λ1, λ2) and theconcentration level of nitric oxide (NO).
 2. The biosensor of claim 1,further comprising at least one of: a wireless transceiver configured totransmit the concentration level of nitric oxide to another device; or aport for a wired connection to communicate the concentration level ofnitric oxide to another device.
 3. The biosensor of claim 1, wherein thefirst wavelength has a high absorption coefficient for nitric oxide inarterial blood flow and is in a range of approximately 370 nm to 410 nm.4. The biosensor of claim 3, wherein the second wavelength has a lowerabsorption coefficient for nitric oxide in arterial blood flow.
 5. Thebiosensor of claim 1, wherein the calibration database includes a rangeof R_(λ1, λ2) values and correlated concentration levels of nitric oxideand wherein the calibration database is generated using nitric oxidelevel measurements obtained from a large sample population.
 6. Thebiosensor of claim 5, wherein the calibration database includesdifferent correlations between the R values and NO concentration levelsdepending on the underlying skin tissue.
 7. The biosensor of claim 1,further configured to: obtain a concentration level of one or morehemoglobin species; and compensate for the concentration level of theone or more hemoglobin species to determine the value R_(λ1, λ2).
 8. Thebiosensor of claim 7, wherein the concentration level of the one or morehemoglobin species is determined by: analyzing spectral response of aplurality of wavelengths to determine differential absorption signalsfor each hemoglobin species; and using a Beer-Lambert matrix equationfor determining the concentration levels of the one or more hemoglobinspecies.
 9. A biosensor for monitoring nitric oxide (NO) of a patient invivo, comprising: a PPG circuit configured to: generate at least onespectral response from light reflected around a range of wavelengthsfrom skin tissue of the patient; a processing circuit configured to:determine an absorbance spectra curve for hemoglobin from the spectralresponse; determine a degree of shift of the absorbance spectra curve ofhemoglobin due at least to a presence of NO; access a calibrationdatabase that include correlations of degrees of shifts of theabsorbance spectra to concentration levels of nitric oxide (NO); andobtain a concentration level of nitric oxide using the calibrationdatabase.
 10. The biosensor of claim 9, wherein the processing circuitis configured to determine a degree of shift of the absorbance spectracurve of hemoglobin by: comparing a peak of the absorbance spectra curveof hemoglobin to an absorption peak of a known absorbance spectra curveof hemoglobin in an absence of NO.
 11. The biosensor of claim 10,wherein the hemoglobin includes deoxygenated hemoglobin and theabsorption peak is around 430 nm in an absence of NO.
 12. The biosensorof claim 11, wherein the processing circuit is configured to determine adegree of shift of the absorbance spectra curve of deoxygenatedhemoglobin by: determining a degree of shift of the peak of theabsorbance spectra curve of deoxygenated hemoglobin from around 430 nm.13. The biosensor of claim 10, wherein the hemoglobin includesoxygenated hemoglobin and the absorption peak is around 421 nm in anabsence of NO.
 14. The biosensor of claim 13, wherein the processingcircuit is configured to determine a degree of shift of the absorbancespectra curve of oxygenated hemoglobin by: determining a degree of shiftof the peak of the absorbance spectra curve of oxygenated hemoglobinfrom around 421 nm.
 15. A method for monitoring nitric oxide (NO) of apatient in vivo, comprising: obtaining at least a first spectralresponse for light reflected around a first wavelength from skin tissueof the patient; obtaining at least a second spectral response for lightreflected around a second wavelength from the skin tissue of thepatient; obtaining a value L_(λ1) using the first spectral response,wherein the value L_(λ1) isolates the first spectral response due topulsating arterial blood flow; obtaining a value L_(λ2) using the secondspectral response, wherein the value L_(λ2) isolates the second spectralresponse due to pulsating arterial blood flow; obtaining a valueR_(λ1, λ2) from a ratio of the value L_(λ1) and the value L_(λ2); andobtaining a concentration level of nitric oxide using the valueR_(λ1, λ2) and a calibration database, wherein the calibration databasecorrelates the value R_(λ1, λ2) and the concentration level of nitricoxide (NO).
 16. The method of claim 15, wherein the first wavelength hasa high absorption coefficient for nitric oxide in arterial blood flowand is in a range of approximately 370 nm to 410 nm.
 17. The method ofclaim 16, wherein the second wavelength has a lower absorptioncoefficient for nitric oxide in arterial blood flow.
 18. The method ofclaim 15, wherein the calibration database includes a range ofR_(λ1, λ2) values and correlated concentration levels of nitric oxideand wherein the calibration database is generated using nitric oxidelevel measurements obtained from a large sample population.
 19. Themethod of claim 18, wherein the calibration database includes differentcorrelations between the R values and NO concentration levels dependingon the underlying skin tissue.
 20. The method of claim 15, furthercomprising: obtaining a concentration level of one or more hemoglobinspecies; and compensating for the concentration level of the one or morehemoglobin species to determine the value R_(λ1, λ2).